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Oklahoma strategic plan for the prevention of mental, emotional, and behavioral disorders

Okla homa Department of Mental Health and Substance Abuse Services Page 1
Oklahoma Strategic Plan for the Prevention of
Mental, Emotional, and Behavioral Disorders
2010
Okla homa Department of Mental Health and Substance Abuse Services Page 2
Foreword
In July 2009, the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS)
was awarded a Strategic Prevention Framework State Incentive Grant (SPF SIG) by the Substance Abuse
and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP).
One of the central requirements of the SPF SIG is to develop a state substance abuse prevention
plan using the Strategic Prevention Framework (SPF) model.
While the Oklahoma Strategic Plan for the Prevention of Mental, Emotional, and Behavioral Disorders
will act as the state’s roadmap for its SPF SIG initiatives, it is intended for a larger purpose,
encompassing Oklahoma’s vision for building a strong prevention infrastructure for a broad array of
related mental, emotional, and behavioral disorders. The Plan reflects statewide input from community
representatives and experts in substance abuse and related fields who participated in the planning
process. The Plan provides clear direction and common ground for future endeavors addressing the
prevention of substance abuse, the prevention of mental illness, and mental health promotion.
The commitment and cooperation of those involved in the planning process for the Oklahoma Strategic
Plan is unprecedented. It speaks to the gravity of mental, emotional, and behavioral disorder issues in
our communities. Oklahoma’s Strategic Plan provides the opportunity to initiate collective action among
diverse groups and restore and strengthen our youth, families, and communities.
Terri White
Commissioner, Oklahoma Department of Mental Health and Substance Abuse Services
Secretary of Health
Okla homa Department of Mental Health and Substance Abuse Services Page 3
Table of Contents
I. Background
State Incentive Cooperative Agreement (SICA) ................................................................................4
Mission .............................................................................................................................................4
Vision ................................................................................................................................................4
Goals .................................................................................................................................................4
Oklahoma Logic Model ......................................................................................................................5
Theoretical Framework .....................................................................................................................6
II. Assessment
Assessing the Problem ......................................................................................................................9
Assessing the Current Prevention System (Capacity and Infrastructure) ...................................... 20
Criteria and Rationale for SPF SIG Priorities ................................................................................... 22
Description of SPF SIG Priorities ..................................................................................................... 26
III. Capacity Building
Areas Needing Strengthening ........................................................................................................ 28
State‐ and Community‐level Activities ........................................................................................... 28
Role of the SEOW ........................................................................................................................... 30
IV. Planning
State Planning Model ..................................................................................................................... 33
Community‐based Activities........................................................................................................... 35
Allocation Approach ....................................................................................................................... 35
Implications of Allocation Approach .............................................................................................. 36
V. Implementation
Training and Technical Assistance System ..................................................................................... 37
Training Procedures ....................................................................................................................... 37
VI. Evaluation
Surveillance, Monitoring, and Evaluation Activities ....................................................................... 38
Process Evaluation......................................................................................................................... 38
Outcome Evaluation ....................................................................................................................... 38
Tracking ......................................................................................................................................... 38
Expected Change ............................................................................................................................ 39
NOMs Collection and Submission .................................................................................................. 39
VII. Cross‐Cutting Components and Challenges
Cultural Competence ...................................................................................................................... 40
Sustainability ................................................................................................................................. 40
Challenges ..................................................................................................................................... 41
Appendices
Oklahoma Prevention Leadership Collaborative Membership ..................................................................... 44
State Epidemiological Outcomes Workgroup Membership ......................................................................... 45
Regional Area Prevention Resource Center Network Map .......................................................................... 47
Epidemiological Data Sources ....................................................................................................................... 48
SPF SIG Timeline and Milestones .................................................................................................................. 52
References ................................................................................................................................................... 53
Epidemiological Data Tables ......................................................................................................................... 54
Formula Example—Scoring Analyses of the Prescription Drug Substance Category ................................... 61
Okla homa Department of Mental Health and Substance Abuse Services Page 4
I. Background
State Infrastructure Cooperative Agreement (SICA)
A state substance abuse prevention plan was developed in 2005 as a result of Oklahoma’s previous
infrastructure cooperative agreement with SAMHSA/CSAP known as the State Incentive Cooperative
Agreement, or SICA. Several significant improvements in the state’s prevention service delivery system
were made as a result of this past assessment and planning effort, including the adoption of a SPF‐based
community workplan utilized by providers, development of the Oklahoma Prevention Needs Assessment
survey, and a commitment to fund evidence‐based prevention practices.
Like SICA, the SPF SIG is an infrastructure cooperative agreement aimed at changing the way that
prevention is implemented in Oklahoma. SAMHSA conceived the SPF as a process through which all
state prevention resources may be aligned and performance of the substance abuse prevention portion
of the SAPT Block Grant organized and managed. Oklahoma will use its SPF SIG funding to develop an
infrastructure that supports bringing together multiple funding streams from multiple sources with the
common goal of creating and sustaining a community‐ and evidence‐based approach to substance abuse
and mental illness prevention and mental health promotion.
Mission
The mission of this Strategic Plan is to implement and sustain comprehensive, statewide prevention
efforts that are evidence‐based and accountable to the state’s citizens, encourage the collaboration of
multiple agencies and organizations, and enhance the capacity of communities to provide an effective
and comprehensive system of prevention services reflective of community needs and resources.
Vision
The Strategic Plan provides a vision of a future for Oklahoma in which every citizen is provided the
opportunity to achieve a state of health and well‐being free from the scourge of mental, emotional, and
behavioral disorders.
Goals
1) Prevent the onset and prevent/reduce the problems associated with the use of alcohol, tobacco,
and other drugs across the lifespan as identified and measured using epidemiological data.
2) Prevent the onset and prevent/reduce the problems associated with mental and emotional
disorders as identified and measured using epidemiological data.
3) Use the SPF process to create prevention‐capable communities where individuals, families, schools,
workplaces, communities, and the state have the capacity and infrastructure to prevent substance
abuse and mental illness.
4) Develop systematic processes to collect and analyze data regularly to accurately assess the causes
and consequences of alcohol and other drug use.
5) Develop data‐driven decision methods to use prevention resources effectively.
Okla homa Department of Mental Health and Substance Abuse Services Page 5
6) Increase the use of prevention services that are evidence‐based, implemented with fidelity, and
evaluated for effectiveness.
7) Increase the capacity of prevention providers to meet the behavioral health prevention needs of
diverse individuals and communities in a timely, culturally competent manner.
8) Actively seek opportunities to collaborate and coordinate prevention efforts and resources across
sectors to achieve significant, population‐level behavioral health outcomes.
Oklahoma Logic Model
To prevent the onset and prevent/reduce the problems associated with the use of alcohol, tobacco, and
other drugs across the lifespan, Oklahoma will work from a theory of change that is supported through
research. Research has shown changing population behavior requires targeting resources to issues
influencing that behavior (intervening variables, or risk or causal factors). Once these issues have been
identified, a comprehensive set of state and community evidence‐based strategies can be selected and
employed. It also is important to evaluate the effectiveness of the state and community efforts at each
phase through process, immediate, intermediate, and long‐term outcome data collection.
NEEDS ASSESSMENT
PLANNING
State
Strategies
State
Workplan
Community
Strategies
Community
Workplan
EVALUATION
Impact Long‐Term
Outcomes
Intermediate
Outcomes
Immediate
Outcomes
Process
Measures
Consumption
Intervening
Variables
Risk/Causal
Factors
Consequence
Okla homa Department of Mental Health and Substance Abuse Services Page 6
Theoretical Model
Conceptual and theoretical approaches to prevention rest on a number of assumptions. First,
prevention is viewed as a proactive process by which conditions that promote well‐being are created.
Prevention activities empower individuals and communities to meet the challenges of life events and
transitions by creating conditions and reinforcing individual and collective behaviors that lead to healthy
communities and lifestyles.
Second, prevention requires multiple processes on multiple levels to protect, enhance, and restore the
health and well‐being of communities and the state. State departments and community organizations
may emphasize a number of different processes in seeking to realize the goals of the Oklahoma
Strategic Plan—all with very little overlap or duplication. Although their focus on and approach to
prevention may differ—as mandated by funding and regulatory sources—they may share similar
processes and elements, such as needs assessment activities and the development and nurturing of
community collaboratives, which can be strengthened through communication and coordination.
Third, prevention is based on the understanding that there are risk and protective factors that vary
among individuals, age groups, racial and ethnic groups, communities, and geographic areas. Theories,
models, and data that allow for the explanation and understanding of risk and protective factors at
several levels of social aggregation—community, school, peers, family, and the individual’s
characteristics—provide a rational approach to designing prevention strategies and programs. The
Hawkins and Catalano risk and protective factors model is the conceptual approach currently practiced
within the Oklahoma State Department of Mental Health and Substance Abuse Services and provides
the framework for conceptualizing prevention efforts within the Oklahoma Strategic Plan.
Risk factors exist in clusters rather than in isolation. For example, children who suffer abuse or neglect
frequently are found in single‐parent families of low socioeconomic status living in disadvantaged
neighborhoods inundated with violence, drug use, and crime. Research has shown that multiple risk
factors have a synergistic effect (i.e., the interactions between these risk factors have a greater effect
than any single risk factor produces alone). Therefore, the more risk factors a child is exposed to, the
greater the likelihood that he or she will, for example, use drugs, become violent, or engage in criminal
behavior.
However, Oklahoma understands that achieving significant, population‐based behavior change requires
more than just making a positive impact on the underlying conditions (i.e., risk and protective factors); it
requires significant and measurable reductions in the causal factors related to mental, emotional, and
behavioral disorders.
The idea of multiple influences affecting behavioral outcomes is evident in the causal factor research
conducted by the Pacific Institute for Research and Evaluation (PIRE). PIRE has identified seven causal
factors or areas of intervention that can make drug using behaviors—and therefore the profusion of
health, social, and economic problems related to drug use—more or less likely to occur.
Economic availability (accessibility according to price), retail availability (accessibility from retail
Okla homa Department of Mental Health and Substance Abuse Services Page 7
sources), and social availability (accessibility from nonretail sources, such as family and friends) are key
areas of influence, since without availability there can be no substance use and no associated problems.
Promotion—alcohol and tobacco manufacturers’ and retailers’ attempts to increase demand through
the advertising and promotion of their products—is another identified causal factor. Community norms
regarding the acceptability of high‐risk behaviors, including substance use, may be codified into concrete
expressions such as public policies, laws, and regulations. In addition to directly defining undesired
illegal substance use, these community norms can affect other areas of intervention (e.g., availability
and promotion), shaping both demand and supply. The degree to which laws and regulations limit
availability, regulate promotion, or reduce undesired use is directly related to their enforcement. Finally,
individual characteristics—genetics, values, attitudes, and social associations—also contribute to
individual substance use decisions.
Oklahoma’s commitment to the risk and protective factor model is in alignment with PIRE’s causal factor
model, which represents a public health approach to prevention and emphasizes prevention effects at
the community level. Oklahoma appreciates that communities are complex systems with complicated
and shifting interactions among and between their parts, and recognizes that preventing mental,
emotional, and behavioral disorders requires a comprehensive, systematic approach based on a clear
understanding of each contributing causal factor and the relationship between those factors. Knowing
how—and where—to effectively intervene is essential to achieving population outcomes.
The SPF model also employs a public health approach that focuses on achieving population
outcomes. In instituting the SPF process, Oklahoma is transitioning from a focus on services to
individuals or small groups of consumers to population‐based approaches that view community well‐being
as the unit of outcome measurement, and from agency‐centered services to coordinated,
multisector systems approaches that use evidence‐based practices to achieve and change.
ODMHSAS and its state‐ and community‐level partners are committed to implementing the five steps of
the SPF process to enhance state and community prevention system accountability, capacity, and
effectiveness. This dynamic, systematic process to build infrastructure and capacity and achieve results
provides a logical framework that addresses five key steps:
1. Assessment of substance abuse and related problems, resources and gaps, contextual conditions,
and readiness to act through data collection and analysis
2. Mobilization of stakeholders and
financial/organizational capacity
building at state and community
levels to address the priority issues
identified in the assessment process
3. Development of a comprehensive
strategic plan that aligns resources
with locally, culturally, and
Okla homa Department of Mental Health and Substance Abuse Services Page 8
developmentally appropriate strategies that have been documented to be effective in addressing
the state’s/community’s identified priority issues
4. Implementation of state/local strategic plan that identifies timelines, processes, activities, and
responsibilities
5. Ongoing evaluation and monitoring of progress toward achieving outcomes, making adjustments as
needed to ensure continuous improvement.
The SPF is an iterative process in which each step tests the validity of conclusions drawn in previous
steps—sometimes requiring revisions to earlier assumptions. Oklahoma will continually assess new
information. Initially the focus will be on substance abuse‐specific data relative to the SPF SIG priorities,
but over time the state plans to expand its assessment to include related prevention areas such as child
abuse, domestic violence, and suicide. Based on data analysis findings, the state will mobilize new
stakeholders and partners, as appropriate; continue to build capacity to deal with broader and more
complex issues; plan and implement new or expanded initiatives; and evaluate progress in building
system capacity and achieving identified outcomes at the state and local levels.
The SPF includes interwoven emphases on cultural competence and sustainable systems and outcomes.
It is essential to recognize that every Oklahoma community is composed of subgroups with unique
and complex cultural needs, and to include these diverse populations in every facet of prevention
planning. Oklahoma also will work to develop the organizational capacity and stakeholder
commitment needed to create an adaptive and effective prevention system that can achieve and
maintain the desired long‐term results, resulting in a dynamic and sustainable prevention system.
Because the Oklahoma Department of Mental Health and Substance Abuse Services is responsible for
providing services to Oklahomans who are affected by mental illness as well as substance abuse, the
infrastructure built by the Department using its SPF SIG funding will provide a foundation for the
prevention of the myriad mental, emotional, and behavioral disorders, many of which share the same
risk and causal factors and could benefit from shared interventions using proven, evidence‐based
practices and expanded community‐based services.
The Oklahoma Strategic Plan for the Prevention of Mental, Emotional, and Behavioral Disorders supports
Oklahoma’s broadened focus on multisector prevention systems development, affording the state
expanded opportunities for multiagency cooperative interventions using shared strategies to serve the
same or similar populations or to target mutual outcomes, and encourages the application of systems
theory and knowledge to design and evaluate comprehensive prevention initiatives.
Okla homa Department of Mental Health and Substance Abuse Services Page 9
II. Assessment
Assessing the Problem
Epidemiology, the science of public health, provides vital information about disorders that threaten the
health and well‐being of populations. Epidemiological data identify problems, help determine what
areas and who are affected by the problems—knowledge that is essential for effective intervention—
and measure the success of interventions aimed at preventing or reducing these problems. Engagement
in a thoughtful planning process that includes careful assessments of needs, resources, capacity,
readiness, and contextual conditions—prior to selecting strategies—is essential to successful prevention
efforts.
This data focus—collection, analysis, and use—is entrenched in each step of the SPF and continually
informs the process. The formal assessment of contextual conditions, needs, resources, readiness, and
capacity is used to identify priority issues in Step 1. In Step 2, data are shared to generate awareness,
spur mobilization, and leverage resources. In Step 3, assessment data are used to drive the development
of a strategic plan and guide the selection of evidence‐based strategies. Data are used in Step 4 to
inform (and, if necessary, revise) the implementation plan. And finally, data are collected to monitor
progress toward outcomes, and findings are used to make adjustments and develop sustainable
prevention efforts.
The Oklahoma State Epidemiological Outcomes Workgroup (SEOW) is a multidisciplinary workgroup
whose members are connected to key decision‐making and resource allocation bodies in the state. This
workgroup, funded through a Federal grant from SAMHSA/CSAP, was established by ODMHSAS in 2006
and is patterned after the National Institute on Drug Abuse (NIDA) community epidemiological
workgroup. Oklahoma’s SEOW is charged with improving prevention assessment, planning,
implementation, and monitoring efforts through data collection and analysis that accurately assesses
the causes and consequences of the use of alcohol, tobacco, and other drugs and drives decisions
concerning the effective and efficient use of prevention resources throughout the state.
To study the nature and extent of the problem of alcohol, tobacco, and other drug use in Oklahoma, the
state’s SEOW utilized the CSAP model of consumption and consequence constructs and indicators. Table
1 provides a complete listing of alcohol, tobacco, and illicit and prescription drug consumption and
consequence constructs. For each construct, one or more identifiable indicators (measures) were used
to quantify consumption and substance‐related consequences. Unlike the underlying constructs, these
indicators are precisely defined and determined by specific data sources. Thus, while “alcohol‐related
mortality” is a relevant construct for monitoring trends of an important consequence of use, it does not
provide a precise definition of how this construct can be measured. However, a number of indicators do
provide specific measures of this construct (e.g., annual incidence rate of deaths attributable to alcohol‐related
chronic liver disease, suicide, homicide, or crash fatalities). A list of constructs and indicators for
alcohol and illicit drug consumption and consequences appear in the epidemiological data tables on
pages 54–59.
Okla homa Department of Mental Health and Substance Abuse Services Page 10
CSAP recommendations were not available for prescription drugs, so Oklahoma used the same data
sources CSAP recommended for the other constructs and indicators.
Table 1. Alcohol, Tobacco, Illicit Drugs, and Prescription Drug Consumption and Consequence Constructs
Alcohol Tobacco Illicit Drugs Prescription Drugs
Consumption • Current use •Current use • Current use
• Age of initial use •Lifetime use
•Age of initial use
• Drinking and driving
Consequence •Alcohol‐related mortality
• Alcohol‐related Crime
•Dependence or abuse
•Total cigarette use
consumption per
capita
• Apparent per capita alcohol
• Alcohol‐related motor vehicle
crashes
•Tobacco‐related
mortality
•Illicit drug‐related
mortality
•Illicit drug‐related
crime
•Dependence or
abuse
•Prescription opiate‐related
mortality
• Current use
• Heavy drinking
• Age of initial use
• Current binge drinking
• Alcohol use during pregnancy
•Tobacco use during
pregnancy
The SEOW required data indicators for each substance to be readily available and accessible, with the
measure available in disaggregated form at the State or lower geographic level. The method or means of
collecting and organizing the data also had to be consistent over time; if for any reason the method of
measurement had changed, reliable data had to be available to allow adjustment for differences
resulting from data collection changes. In addition, research‐based evidence had to support that the
indicator accurately measured the specific construct and yielded a true representation of the
phenomenon at the time of assessment, with data collected—preferably on an annual, or at minimum, a
biennial basis—for the preceding 3 to 5 years. And each indicator had to be sufficiently sensitive to
detect change over time that might be associated with changes in alcohol, tobacco, or illicit drug use.
Alcohol Consumption
According to Oklahoma’s Youth Risk Behavior Survey (YRBS), in 2009, 39.0 percent of students in grades
9–12 reported current alcohol consumption. That percentage is consistent with data collected by the
National Survey on Drug Use and Health (NSDUH) for the population aged 12 and older, which showed
42.5 percent of respondents were current drinkers in 2007. YRBS data also showed 28 percent of
adolescents were binge drinkers at the time of the survey. Although youth binge drinking is on the
decline, with the exception of 2009, Oklahoma has been consistently above the national average for this
behavior according to the YRBS. NSDUH data from 2007 indicated 37.4 percent of 18‐ to 25‐year‐olds
and 9.0 percent of 12‐ to 17‐year‐olds were binge drinkers. The 2009 YRBS showed 19.4 percent of
Oklahoma students in grades 9–12 reported early initiation of alcohol; a continued indication of a steady
decline in that behavior since the 2003 YRBS report of 26.8 percent.
While adolescent drinking and driving is trending downward, Oklahoma continues to have percentages
higher than the national average. In 2003, Oklahoma’s percentage of adolescent drunk driving was 17.5
percent, which was 45 percent higher than the national average. This dropped to 11.0 percent in 2009,
which was 13 percent higher than the national average of 9.7 percent.[1]
Okla homa Department of Mental Health and Substance Abuse Services Page 11
Figure 1.YRBS 2003–2007 Percentage of Students in Grades 9–12 Who Reported
Driving When They Had Been Drinking
Indicators from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) show Oklahoma is lower
than the national average in current alcohol consumption, heavy consumption, and binge drinking
among adults. In 2009, 42.6 percent of Oklahoma adults reported current alcohol consumption, which
was 27 percent lower than the national average of 54.3 percent.[2]
Although lower than the national average, NSDUH data indicates Oklahoma’s percentage of binge
drinking among persons 12 and older has increased from 2003‐2007. The percentage was 19.01 in 2003
and 21.2 in 2007.[3]
Figure 2. BRFSS 2009 Alcohol Consumption Categories
Data from the Pregnancy Risk Assessment Monitoring Survey (PRAMS) show that alcohol use among
pregnant women has been climbing in Oklahoma since 2003, when 2.5 percent of pregnant women had
consumed alcohol during the last 3 months of their pregnancy. In 2007, the percentage had increased to
4.8 percent of pregnant women.[4]
Alcohol Consequences
Oklahoma is consistently above the national average in alcohol‐related mortality. Long‐term alcohol
consumption is associated with chronic liver disease. The relationship between alcohol use and suicide is
also well documented, according to CSAP. Both chronic liver deaths and suicide deaths have been on the
rise in Oklahoma since 2003.[5,6,7]
17.5
12.3 13.3
11.00
12.1
9.9 10.5 9.7
0
5
10
15
20
2003 2005 2007 2009
Oklahoma
Nation
42.6
12.9
3.4
54.3
15.7
5.1
0
10
20
30
40
50
60
Current
Drinker
Binge Drinker Heavy Drinker
Oklahoma
Nation
Okla homa Department of Mental Health and Substance Abuse Services Page 12
Figure 3. 2003–2006 National Vital Statistics System (NVSS)
Oklahoma Chronic Liver Disease and Suicide Mortality
Data Deaths per 100,000
According to the Uniform Crime Reports (UCR), Oklahoma has also been consistently above the national
average in crimes related to alcohol use which include aggravated assaults, sexual assaults, and
robberies. Since 2003, there has been an 18.1 percent increase.[8]
Figure 4. 2005–2008 UCR Number of Violent Crimes Reported to Police Per 100,000
Population
Fatality Analysis Reporting System (FARS) data show that Oklahoma has maintained a steady rate of
fatal crashes involving an alcohol‐impaired driver. In 2003, Oklahoma’s alcohol‐impaired driver fatality
rate was 31.3 percent, and in 2008, that figure remained relatively stable at 31.6 percent. National
percentages for those years were 30.3 and 31.4, respectively.[9]
Tobacco Consumption
According to the 2007 NSDUH, 30.6 percent of Oklahomans aged 12 and older were current cigarette
smokers, which was above the national average of 24.2 percent. Data from the 2009 BRFSS also showed
Oklahomans’ daily cigarette smoking exceeding that of the United States population as a whole, at 25.4
percent vs. 17.9 percent, respectively.[2,3]
The YRBS shows indicators in tobacco use among adolescents have been falling in Oklahoma since 2003,
with students who smoked their first cigarette before the age of 13 decreasing by half since that year.[1]
9.413.6 10.314.4 11.314.7 12.415.0
0
5
10
15
20
2003 2004 2005 2006
Chronic Liver
Disease
Suicide
508.6
497.4 499.6
526.7
469.0 473.6 466.9
454.5
400.0
420.0
440.0
460.0
480.0
500.0
520.0
540.0
2005 2006 2007 2008
Oklahoma
Nation
Okla homa Department of Mental Health and Substance Abuse Services Page 13
Figure 5. YRBS 2003–2009 Percentage of Students in Grades 9–12
Who Reported Smoking a Whole Cigarette for the First
Time Before the Age of 13.
Smoking among pregnant women is climbing in Oklahoma according to PRAMS. In 2003, 16.2 percent of
pregnant women reported they had smoked during the last 3 months of their pregnancy; in 2007, the
most recent PRAMS for which data are currently available, the percentage of pregnant women who
smoked during the last 3 months of pregnancy had jumped to 21.3.[4]
Tobacco Consequences
National Vital Statistics System (NVSS) data show deaths from both chronic obstructive pulmonary
disease (COPD) and emphysema for Oklahoma are above the national average.[10]
Figure 6. NVSS 2006 COPD/Emphysema and Lung Cancer Deaths Per 100,000
Illicit Drug Consumption
The YRBS shows daily marijuana use for high school students in grades 9–12 is decreasing; 22.0 percent
were daily users in 2003, while just 15.9 percent reported this behavior in 2007.[1]
According to NSDUH, Oklahoma has been consistently above the national average among persons aged
12 and older reporting the use of any illicit drug other than marijuana. The percentages were 4.1 in 2004
and 4.6 in 2007. The national percentages for those same years were 3.4 and 3.7, respectively.[3]
23.7
20.2
15.6
11.5
0
5
10
15
20
25
2003 2005 2007 2009
Oklahoma
60.0
68.2
40.5
53.1
0.0
20.0
40.0
60.0
80.0
COPD/Emphysema Lung Cancer
Cause of Death
Oklahoma
Nation
Okla homa Department of Mental Health and Substance Abuse Services Page 14
Although still above the national average, youth methamphetamine use continues to decline in
Oklahoma according to the YRBS. Since 2003, the percentage of youth methamphetamine users has
dropped by half.[1]
Figure 7. YRBS 2003‐2009 Percentage of Oklahoma Students in Grades 9–
12 Who Reported Ever Using Methamphetamines
The YRBS also shows Oklahoma exceeds the national average in cocaine, ecstasy, steroid, and inhalant
use. Although above the national average, cocaine use in Oklahoma has dropped from 9.2 percent in
2003 to 7.4 percent in 2009.[1]
Although initially below the national average in years 2003–2007, adolescent use of inhalants is on a
steady ascent. In 2009, 12.7 percent of Oklahoma adolescents reported inhalant use, surpassing the
national average of 11.7 percent.[1]
Figure 8. 2003‐2009 YRBS Percent of Students in Grades 9–12 Who Reported
Ever Using Any Form of Inhalant
Illicit Drug Consequences
The latest NVSS data show that Oklahoma exceeds the Nation in number of deaths due to drug‐related
behavior. In 2006, the rate per 100,000 was 17.3 for Oklahoma and 12.8 for the United States as a
whole.[5]
9.9
7.1
5.5
4.8
0
2
4
6
8
10
12
2003 2005 2007 2009
9.9
12.0 11.7
12.1 12.4 12.7
13.3
11.7
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
2003 2005 2007 2009
Oklahoma
Nation
Okla homa Department of Mental Health and Substance Abuse Services Page 15
The number of drug‐related crimes (larceny, burglary, motor vehicle theft) in Oklahoma also outstrips
that of the Nation; in 2008, Oklahoma reported 3,442.4 per 100,000 compared to the national rate of
3,212.5 per 100,000. However, Oklahoma’s 2008 rate does represent a decline for the state, which
reported drug‐related crimes of 4042.0 per 100,000 in 2005.[8]
Prescription Drug Consumption
According to data from the 2007 NSDUH, Oklahomans aged 12 and older exceeded the national average
for the consumption of painkillers for nonmedical use by 232 percent. This is a 22 percent increase since
2004.[3]
Prescription Drug Consequences
Although hospital inpatient discharge data were not indicators used in scoring, they were presented to
the State Epidemiological Outcomes Workgroup (SEOW) due to the paucity of indicators regarding
prescription drugs. Oklahoma hospital data associated with opiates have shown a 91 percent increase
since 2003. Although this is a general category for opiates, for all practical purposes, heroin is the only
illicit opiate taken into account.[11]
NVSS data show there has been a 328 percent increase in opiate‐related deaths in Oklahoma since 1999.
In 2006, Oklahoma ranked 4th in the Nation for opiate overdose deaths, exceeding the national average
by 123 percent.[12]
Figure 9. NVSS 1999‐2006 Opioid Overdose Deaths Per 100,000 Population
Mental and Emotional Disorders
The Oklahoma SEOW intends to expand its scope to collect and analyze epidemiological data on the
nature and extent of mental illness and related indicators in the state. The broadening of the SEOW’s
scope of work is critical for Oklahoma to gain more understanding about opportunities for mental illness
prevention and mental health promotion within the state. In addition, developing research supports the
connection between mental and emotional disorders, their causal factors, and other behavioral health
problems, including substance abuse. Therefore, it is imperative that Oklahoma apply the same
0
2
4
6
8
10
12
1999 2000 2001 2002 2003 2004 2005 2006
Rate
Oklahoma
US
.
Okla homa Department of Mental Health and Substance Abuse Services Page 16
assessment standards integral to the SPF process for the prevention of mental and emotional disorders
as has been done for substance abuse.
Mental disorders (brain dysfunction disorders) account for 25 percent of disability in the United States.
About 22 percent of the U.S. adult population has one or more diagnosable disorders in a given year.
Oklahoma currently ranks number one in the Nation for the prevalence of these disorders in adults.[13]
Mental illness can influence the onset, progression, and outcome of other illnesses. Anxiety, impulse
control, and mood disorders often correlate with health risk behaviors such as substance abuse, tobacco
use, and physical injury. Depression is a risk factor for such chronic illnesses as hypertension,
cardiovascular disease, and diabetes. Mental illness and depression also increase the risk for suicide.
Oklahoma has consistently had a higher number of suicide deaths compared to the rest of the Nation. In
Oklahoma, suicide is the most common manner of violent death. The first quarter of 2010 has yielded a
sharp increase in calls to Oklahoma’s suicide prevention hotline. In 2009, for example, there were 833
calls during the first quarter. In the first quarter of 2010 there has been a 53.0 percent increase, with
1,272 clients having called the hotline.[14]
From 2004–2007, the rate of suicide was 14.4 per 100,000 according to the Oklahoma Violent Death
Reporting System (OVDRS). Data from OVDRS also show that suicide was the third‐leading cause of
death among 15‐ to 24‐year‐olds in 2007. The suicide rate reported by Oklahoma for this population was
13.5 percent higher than the national rate among the corresponding age group. And in fact, among all
ages, Oklahoma’s reported suicide rate is higher than the national average. In 2006, Oklahoma’s rate per
100,000 was 15.0, compared to the national average of 10.9. Seventy‐eight percent of suicides were
males. Depression was the leading circumstance associated with suicide. Forty‐six percent of suicides
were the result of a depressed mood. Substance use also played a role in suicides according to OVDRS.
Thirty percent of persons tested had a positive blood alcohol test, and 88 percent tested positive for
other drugs.[15]
In 2007, NSDUH reported that 14.0 percent of Oklahomans aged 18 and older suffered from serious
psychological distress. Table 2 shows several mental health indicators for which Oklahoma had some of
the highest percentages in the Nation in 2006–2007. In addition, results from the 2009 BRFSS show 20.7
percent of Oklahoma adults had between 1 and 13 mentally unhealthy days in the last month, and 13.7
percent had between 14 and 30 such days.[3]
Table 2. NSDUH, 2006–2007 Annual Averages
Mental Health Indicator Percent
Serious psychological distress in the past year (age 18 and older) 14.0
Serious psychological distress in the past year (age 26 and older) 13.2
Persons having at least one major depressive episode in the past year (age 18 and older) 9.1
Persons having at least one major depressive episode in the past year (age 18–25) 10.5
Persons having at least one major depressive episode in the past year (age 26 and older) 8.9
Okla homa Department of Mental Health and Substance Abuse Services Page 17
ODMHSAS reported 34,132 persons received ODMHSAS‐funded mental health services for fiscal year
2004. In 2009, that number increased to 52,226. In 2009, the top three reasons clients sought services
were emotional maladjustment/disturbance (38.9 percent), substance abuse disorders (29.0 percent),
and depressive disorders (7.0 percent). The top drug of choice was alcohol. The age groups of clients
that had the highest percentages of service were 25–34 (23.5 percent) and 35–44 (21.0 percent). The
gender breakdown of clientele was virtually the same. Of the clients who were given a substance abuse
screening, 57.0 percent tested positive.[16]
The number of children with serious emotional disturbance (SED) receiving ODMHSAS‐funded mental
health services increased 76 percent over a 5‐year period, from 2,254 in 2004 to 3,959 in 2009. Persons
with serious mental illness (SMI) receiving ODMHSAS‐funded mental health services increased from
25,492 in 2004 to 38,222 in 2009—an increase of approximately 50 percent.[16]
Data from the YRBS show that, in 2009, 28.2 percent of students felt sad or hopeless everyday day for 2
weeks or more in a row to the extent that they stopped doing some usual activities during the past 12
months; this was slightly higher than the national average of 26.1 percent.[1] Oklahoma Systems of Care,
a comprehensive spectrum of mental health and other support services for adolescents and their
families with a serious emotional disturbance, has experienced a 73 percent increase in enrolled clients
since fiscal year 2006—jumping from 456 in 2006 to 787 in 2010. The majority of clients are white, male,
and diagnosed with conduct disorders.[17]
Populations of Note
American Indian
In 2000, the American Indian and Alaska Native (AI/AN) population in Oklahoma was 266,801,
comprising 8 percent of the state’s total population and ranking Oklahoma second among all states for
AI/AN population. Alcohol and tobacco consumption is a significant problem in this population.
According to data from the 2009 BRFSS, 14.2 percent of AI/AN adults reported binge drinking, and 4.0
percent reported heavy drinking; both percentages exceed those reported by any other race. Smoking
consumption was also highest among this group according to the BRFSS. In 2009, 31.9 percent AI/ANs
reported current smoking compared to all other races (25.0 percent).
Data from the Oklahoma State Bureau of Investigation (OSBI) show Oklahoma’s AI/AN population had
substantially greater alcohol‐related arrests (i.e., driving under the influence, liquor law violations and
drunkenness) at 44 percent; lower drug law violation arrests (i.e., all drug arrests reported as
sale/manufacturing and possession) at 8 percent; and lower index crime arrests (i.e., murder, rape,
robbery, aggravated assault, burglary, larceny, and motor vehicle theft) at 10 percent, compared to all
races combined (29 percent, 14 percent, and 13 percent, respectively).
From fiscal years (FYs) 2001–2008, Oklahoma’s AI/AN population had consistently high rates of persons
served in substance abuse treatment facilities compared to Whites and people of all races combined.[18]
Older Adults
Older Oklahomans, aged 65 and above, are the fastest growing segment of the state’s population. In
2006, Oklahoma had the 19th‐highest number of persons aged 65 and over, with 475,637 individuals
Okla homa Department of Mental Health and Substance Abuse Services Page 18
falling into this category (U.S. Census Bureau, 2006). The population ages 60 and older increased by 18.2
percent from 1980 to 2000. This is substantially higher than the national average of 12.4 percent. In
2000, Oklahoma ranked 13th in terms of the percentage of the total population 60 years and older .This
high growth rate among senior citizens outpaced Oklahoma’s overall growth rate of 14 percent for the
same period. The very old (85 years and older) experienced the most notable growth rate of 61 percent
from 1980 to 2000. It is estimated that while Oklahoma’s total population will grow at a relatively slow
pace (10.2 percent), those 65 years and over will increase by over 60 percent between 2007 and 2030.
Further, the state’s population ages 85 years and older is expected to increase by 50 percent during the
same time period (U.S. Census Bureau, 2006).[13]
Figure 10.
According to Oklahoma’s 2009 BRFSS, 78.8 percent of persons aged 65–74 said that they always or
usually received social and emotional support. This was down from 2005, when the percent was 83.1.
Conversely, this among persons aged 75 and older, 77.6 percent always or usually received support in
2005 and 78.4 percent did in 2009.[3]
Another significant characteristic within the state’s older populations is grandparents raising
grandchildren. Approximately 43,000 older Oklahomans are responsible for their grandchildren; of
these, 16,200 have been responsible for the care of their grandchildren 5 years or longer. Grandparents
living with grandchildren under 18 years of age for the population 30 years and over households are
shown in the following table.[13]
0
10
20
30
40
50
60
70
80
1980-90 1980-2000
Percent growth 1980–1990, 1980–2000
Total OK pop
60 +
85 +
Okla homa Department of Mental Health and Substance Abuse Services Page 19
Household types United States Oklahoma
Total households 30+ years 158,881,037 1,915,455
Grandparents living with grandchildren under 18 5,771,671 67,194
Grandparents responsible for their grandchildren 2,426,730 39,279
Grandparents responsible for their grandchildren 5 years or more 933,408 14,714
Source: U.S. Census 2000
Veterans and Military Families
In Oklahoma, 12.5 percent (333,358) of the state’s citizens are veterans, with 20.7 percent having served
in the Gulf War, 35.1 percent having served in Vietnam Conflict, 12.7 percent having served in the
Korean War, and 13 percent having served in World War II. The American Forces News Services reports
that over 47,000 individuals based in Oklahoma are active in military operations and 24,500 have been
deployed since American troops entered Afghanistan (www.usmilitary.about.com. 2008). In addition to
other mental health disorders, 20 percent of returning veterans suffer posttraumatic stress disorder.[13]
According to the OVDRS, 23 percent of suicide deaths between 2004 and 2007 were veterans, which
represented 76 percent of all violent deaths among veterans.[15] In addition, a comparison of mortality
between Operation Enduring Freedom/Operation Iraqi Freedom Veterans and the general U.S.
population (adjusted for age, sex, race, and calendar year) showed evidence of a 21 percent excess of
suicides among veterans through 2007. Although the evidence is preliminary, it suggests decreased
suicide rates since 2006 among veterans of both sexes aged 18–29 who have used Veterans Health
Administration (VHA) health care services relative to veterans in the same age group who have not. This
decrease in rates translates to approximately 250 lives per year. Finally, more than 60 percent of
suicides among users of VHA services include patients with a known diagnosis of a mental health
condition.[19]
Incarcerated Women
According to the Oklahoma Department of Corrections (ODOC), Oklahoma leads the Nation in the rate
of female offender incarceration at 131 per 100,000 population, a significant departure from the
national average of 69 per 100,000 population. As of 2006, 2,213 women were incarcerated in the State
of Oklahoma, and the state’s female inmate population is growing more rapidly than its male inmate
population. Analogous to this rise in incarcerated females is a rise in incarcerated female drug use (i.e.,
both personal use and drug‐related crimes).
From 2001 to 2007, the number of female prison admissions per year increased by 136 (12 percent). Of
the total female prison admissions during this time, 5,308 (61 percent) were White; 2,141 (24 percent)
were Black; 998 (11 percent) were American Indian or Alaska Native; and 274 (3 percent) were Hispanic.
According to the Bureau of Justice Statistics (2002), 52 percent of the Nation’s female inmates were
dependent on drugs or alcohol. Of all the offenses listed for incarcerated women between 2001 and
2007 in Oklahoma, approximately 70 percent were associated with a controlled substance (i.e., a drug or
chemical substance whose possession and use are controlled by law), alcohol, or both.[18]
Okla homa Department of Mental Health and Substance Abuse Services Page 20
Assessing the Current Prevention System (Capacity and Infrastructure)
At the state level, prevention services are managed through ODMHSAS, which is the Single State
Authority (SSA) responsible for publicly funded substance abuse and mental illness prevention services.
The ODMHSAS Prevention Services Division is led by Commissioner Terri White, Deputy Commissioner
Steven Buck and Division Director Jessica Hawkins, with a management team and staff of 16 full‐time
equivalents funded through multiple state and Federal sources.
A number of different governing groups guide and inform the strategic direction of the state’s substance
abuse and mental health prevention service system:
• The Prevention Services Division is monitored and overseen by the agency’s Governing Board.
• The Oklahoma Prevention Leadership Collaborative (OPLC), developed in 2010, is expected to
serve as a guiding council on state prevention priorities and coordination among state agencies
related to prevention services.
• The ODMHSAS Prevention Services Division staffs three statewide committees charged with
setting priorities on significant state prevention initiatives, including the Governor’s Task Force
on the Prevention of Underage Drinking, the Oklahoma Suicide Prevention Council, and the
Oklahoma Crystal Darkness Collaborative (focusing on the prevention of methamphetamine
use).
• The SEOW was convened to collect and report on substance abuse consumption and
consequence data to help identify and monitor state priorities for ODMHSAS and other
agencies. The Oklahoma SEOW intends to expand its scope to analyze other behavioral and
physical health data as a service to other state agencies using a data‐driven prioritization
process.
• The Oklahoma Prevention Policy Alliance is a nonprofit advocacy organization comprised of
state‐ and local‐level prevention supporters who advance state and municipal prevention‐related
policy agendas.
• The Behavioral Health Development Team (BHDT) is a subcommittee of the State Advisory Team
for Oklahoma’s Systems of Care initiative. The membership of the BHDT includes a designee for
each member of the Partnership Board, which includes all eight child‐serving agencies
(ODMHSAS, Department of Human Services, Department of Rehabilitative Services, Office of
Juvenile Affairs, Oklahoma Commission on Children and Youth, State Department of Education,
Oklahoma Health Care Authority, and Oklahoma State Department of Health). The BHDT's
primary focus is on researching options for developing the needed infrastructure and services
for Systems of Care. The team develops recommendations for the Partnership for Children’s
Behavioral Health Board (PCBH), and creates specific implementation plans based on the
decisions and guidance of the PCBH Board. Recently, the BHDT has adopted a strategic plan that
includes behavioral prevention priorities, including community‐based prevention approaches
(through Oklahoma’s Area Prevention Resource Centers) and suicide prevention.
The Area Prevention Resource Centers (APRCs), which are funded by state‐appropriated funds and the
Federal Substance Abuse Prevention and Treatment (SAPT) Block Grant administered by SAMHSA, are
Okla homa Department of Mental Health and Substance Abuse Services Page 21
the backbone of Oklahoma’s prevention service system. There are 17 regional APRCs serving all 77
counties in Oklahoma. APRC Directors convene quarterly with ODMHSAS staff at the Oklahoma
Prevention Network meetings. APRC staff are certified prevention specialists and receive regular training
on evidence‐based prevention strategies and principles, including the SPF. APRCs develop, in
partnership with community coalitions, community‐level prevention workplans based on the SPF and
aligned with state prevention priorities. Services are focused on achieving sustainable, population‐level
outcomes. APRC staff are charged with implementing community‐level workplans in collaboration with
community coalitions and building local‐level prevention capacity. Services provided and guided by the
APRCs are evaluated at the local level. A contract with the University of Oklahoma’s College of Public
Health, to provide training and technical assistance on evaluation as well as overall Block Grant
evaluation services, is slated to commence in 2010.
The ODMHSAS Prevention Services Division administers 2much2lose (2m2l), which is the overarching
moniker of Oklahoma’s underage drinking prevention initiative funded by the Office of Juvenile Justice
and Delinquency Prevention’s Enforcing Underage Drinking Laws Block Grant program. 2m2l represents
an array of efforts, including a youth leadership development program and underage drinking law
enforcement activities. Regional 2m2l Coordinators provide training and technical assistance to local
2m2l youth chapters and law enforcement throughout the state on best practice strategies for underage
drinking prevention. There is a 10‐member state 2m2l Youth Council that advises ODMHSAS on local and
state youth training, as well as two regional cross‐jurisdictional law enforcement task forces that
implement high visibility underage drinking operations throughout the year.
The ODMHSAS Prevention Services Division also manages a number of other Federal and state
substance abuse prevention grant programs, including the Oklahoma Partnership Initiative funded by
the Administration on Children and Families to provide prevention services to children in substance
abusing families; the Oklahoma Methamphetamine Prevention Initiative funded by SAMHSA/CSAP to
implement evidence‐based meth prevention interventions in high‐risk communities; a responsible
beverage sales and service training program and underage/high‐risk drinking law enforcement effort
funded by a Justice Assistance Grant from the Oklahoma District Attorneys Council; and administration
of a program to prevent youth tobacco retail sales to minors funded by the Oklahoma Tobacco
Settlement Endowment Trust. Finally, ODMHSAS Prevention Services Division has a professional on staff
to develop a statewide infrastructure for Screening, Brief Intervention, and Referral to Treatment
(SBIRT) services and advise on advances in state and Federal health reform as it relates to the
prevention of mental, emotional, and behavioral disorders.
In addition to substance abuse prevention, ODMHSAS Prevention Services Division operates two mental
health promotion initiatives. The Oklahoma Youth Suicide Prevention Initiative is funded by the SAMHSA
Center for Mental Health to implement state and local strategies such as training, screening, and
community capacity building to prevent suicide and develop prepared communities. Second, the Mental
Health First Aid training program supports a network of trainers throughout the state to increase
community knowledge of mental illness, identify warning signs, and administer effective help when
signs are recognized.
Okla homa Department of Mental Health and Substance Abuse Services Page 22
Oklahoma continues to work toward a collaborative substance abuse prevention system that ensures
the use of evidence‐based programs and policies and demonstrates accountability among partners. The
ODMHSAS Prevention Services Division partners with a number of other agencies to coordinate and
implement prevention services. These agencies include, but are not limited to, those shown in the
following table.
Agency Target Population
Cherokee Nation Behavioral Health Services Cherokee Nation
Oklahoma State Department of Education Youth
Oklahoma State Department of Health All Citizens
Oklahoma Department of Public Safety/Highway Safety Office All Citizens
Office of Faith‐based Initiatives All Citizens
Office of Juvenile Affairs Youth
Oklahoma Bureau of Narcotics and Dangerous Drugs All Citizens
Oklahoma Commission on Children and Youth Youth
Oklahoma Health Care Authority All Citizens
Oklahoma Institute for Child Advocacy Youth
Oklahoma National Guard Youth/Military Families
Oklahoma State Regents for Higher Education College
Oklahoma State Parent‐Teacher Association Families
Criteria and Rationale for SPF SIG Priorities
In July 2009, Oklahoma received a 5‐year Strategic Prevention Framework State Incentive Grant from
SAMHSA/CSAP. The ODMHSAS Prevention Services Division administers the Oklahoma SPF SIG project.
The purpose of the SPF SIG funding is for states to build the infrastructure necessary to prevent the
onset and reduce the progression of substance abuse and related problems, as well as build prevention
capacity and infrastructure at the state and community levels. The following describes the processes by
which the state determined substance abuse‐specific priorities for the 5‐year SPF SIG initiative. The
same process will be applied utilizing the infrastructure developed via the SPF SIG to determine
prevention priorities related to mental and emotional disorders.
On March 26, 2010, Oklahoma held its SPF SIG kickoff meeting in Oklahoma City, with members of CSAP
present. At that meeting, the SEOW discussed the existence and purpose of the Oklahoma Tobacco
Settlement Endowment Trust. Oklahoma is the only state in the Nation that has constitutionally
protected the majority of its Master Settlement Agreement (MSA) funds in an endowment to ensure a
growing funding source. Earnings have increased each year from a low of $650K in FY 2002 to a high of
$18M in FY 2010. Given this large, dedicated funding stream, which ensures that funds will be available
for tobacco prevention for many generations to come, the State Tobacco Control Program endorsed the
omission of tobacco issues from consideration by the SEOW in favor of Oklahoma using its SPF SIG
funding to support other substance‐related issues currently receiving less financial support in the state.
Okla homa Department of Mental Health and Substance Abuse Services Page 23
The SEOW was tasked with analyzing the state epidemiological data to determine problem or emerging
alcohol and other drug consumption and consequence patterns. The SEOW decided to categorize
indicators into one of three substance categories: alcohol, illicit drugs, and prescription drugs.
CSAP provides an excellent list of indicators, solid reasoning for selecting these indicators, and equally
sound explanations for the exclusion of certain indicators. On its Web site,
https://www.epidcc.samhsa.gov/background/criteria.asp, CSAP fully details why each indicator was
selected or rejected. It was CSAP’s sound logic that convinced the SEOW to use its recommendation of
indicators for evaluating each substance.
1) National source. The measure must be available from a centralized, national data source.
2) Availability at state level. The measure must be available in disaggregated form at the state (or
lower geographic) level.
3) Validity. There must be research‐based evidence that the data accurately measure the specific
construct and yield a true snapshot of the phenomenon at the time of assessment. These
criteria are used to eliminate measures that look at face value as if they assess a particular
construct, but are in fact poor or unproven proxy measures and thus do not accurately reflect
the construct. Because OPNA is conducted using a convenience sample, the SEOW voted not to
include these data in the process since such data would not be a valid measure of consumption
and consequence at the state level.
4) Trend. The measure should be available for the past 3 to 5 years, preferably on an annual basis,
but no less than a biennial basis. This enables the state to determine not only the level of an
indicator but also its trends.
5) Consistency. The measure must be consistent (i.e., the method or means of collecting and
organizing data should be relatively unchanged over time, such that the method of
measurement is the same from time i to time i+1). Alternatively, if the method of measurement
has changed, sound studies or data should exist that determine and allow adjustment for
differences resulting from data collection changes.
6) Sensitivity. For monitoring, the measure must be sufficiently sensitive to detect change over
time.
To prioritize each of the three substance categories for the State of Oklahoma, a set of consumption and
consequence indicators for each substance type was identified (see pages 54–60), and an index score
was computed for each substance based on the indicator data available to allow prioritization of each
substance category as follows:
1. A ratio comparing Oklahoma to the United States was calculated based on either the percentage
of use or rate of incidence for each year of available data for each consumption and
consequence indicator.
2. The ratios were summed for all of the consumption indicators and divided by the number of
data points to calculate an average of the consumption ratios.
Okla homa Department of Mental Health and Substance Abuse Services Page 24
3. A ratio average was calculated across the consequence indicators for the substance category.
The consequence ratio average was then multiplied by 2 due to CSAP’s history of placing an
emphasis on consequence data.
4. The ratio averages for consequence data and consumption data for each substance were added
together for the ratio score for each substance.
Next, time trends were analyzed to create a trend index for each substance category, increasing the
sensitivity of substance index scores to current trends. Because a general trend could have overlapping
confidence intervals—which may or may not represent a statistically significant trend—Oklahoma felt
the best way to control for this across all data sources was to conduct a regression analysis for each
indicator rather than look for a general trend. If a statistically significant increase was found, the
indicator was assigned a +1, if a statistically significant decrease was noted, the indicator received a ‐1.
If a significant trend was not found, then the indicator scored a 0. The scores for each substance were
then divided by the total number of indicators, and consequence data were multiplied by 2 and added
to the consumption score to create a trend index score for each substance.
To calculate the total index score for each substance category, the time‐trend data and the ratio data
were added together.
An example of the calculation of the substance category scoring method can be found on pages 61–62
of the appendix.
Substance Consumption = Oklahoma Indicator
National Indicator
Substance Consequence = Oklahoma Indicator
National Indicator ⁼ b
a+b
data points of substance
Substance Consumption = Linear Regression of Time Trend of Indicator
Substance Consequence= Linear Regression of Time Trend of Indicator
x+y (2)
data points of substance
Substance Score = c+z
⁼a
Ratio (*2)
⁼ x ( which is +1
increase, 0 no
change, ‐1 decrease)
⁼c
⁼z
⁼ y (which is +1
increase, 0 no
change, ‐1 decrease)
Following are the results of this process:
• Prescription drugs (9.44)
Okla homa Department of Mental Health and Substance Abuse Services Page 25
• Alcohol (3.54)
• Illicit drugs (2.75).
On May 26, 2010, the SEOW discussed the two priorities that had scored the highest in the process—
prescription drug misuse and alcohol use. The SEOW coordinator had reexamined the indicators
comprising each score. Although consequence data were not found to be age related (e.g., no matter
the age of the individual, drinking increased the likelihood of involvement in violent crime), findings
from this examination for the alcohol score clearly illustrated that the consumption indicators that were
above the national average were all youth related:
• Percent of students in grades 9–12 reporting any use of alcohol in the past 30 days
• Percent of students in grades 9‐12 reporting having five or more drinks on at least one occasion
in the past 30 days
• Percent of students in grades 9–12 who reported riding in a car driven by someone who had
been drinking
• Percent of students in grades 9–12 who reported driving when they had been drinking.
As a result, the SEOW elected to focus on underage rather than adult drinking. The nonmedical use of
prescription drugs—which scored nearly threefold higher than alcohol—also was chosen by the SEOW
as a priority issue that should be addressed by Oklahoma through its SPF SIG.
On June 22, 2010, the SEOW coordinator briefly discussed the state’s epidemiological data and the data
prioritization process at a meeting of the OPLC. The OPLC, which acts as the state’s SPF SIG Advisory
Committee, is the state‐level Collaborative established to promote the coordinated planning,
implementation, and evaluation of quality prevention services for children, youth, and families at the
state and local levels, with a particular focus on the prevention of mental, emotional, and behavioral
health disorders, related problems (e.g., alcohol and other drug use), and contributing risk factors.
The OPLC’s membership, as directed by the Oklahoma Secretary of Health and Commissioner of Mental
Health and Substance Abuse Services, includes not only the representation CSAP requires of the SPF SIG
advisory council, but a range of prevention representatives from across sectors (e.g., injury prevention,
child abuse prevention), as well as membership from the state PTA and tribal governments—specifically
those concerned with behavioral health. The group represents a broad array of connected issues. Since
the different problem areas (e.g., substance abuse, suicide, child abuse, etc.) share risk factors,
collaboration between OPLC members offers significant potential for shared interventions. It is the
OPLC’s responsibility to determine whether there is an investment Oklahoma can make as a state to
achieve population outcomes.
The responsibilities of the Council include, but are not limited to: identifying opportunities for
coordination and collaboration on prevention initiatives serving the same populations, using common
strategies, or aiming to achieve similar goals or outcomes; promoting the implementation of best
practices for prevention at the state and local levels; and serving, as requested, in an advisory role on
required state and Federal grant programs. Currently, the OPLC is focused on the SPF SIG funded by
Okla homa Department of Mental Health and Substance Abuse Services Page 26
SAMHSA and administered by ODMHSAS. Collaborative members will advise on important decisions
related to this cooperative agreement throughout the duration of the project.
Therefore, on July 13, 2010, a subgroup of the SEOW presented the workgroup’s findings and
recommendations to the OPLC. The SPF SIG project director, the SEOW coordinator, and the SPF SIG
evaluator provided an overview of the entire SEOW prioritization process; Donald Baker, Ph.D., of the
University of Oklahoma Anne and Henry Zarrow School of Social Work, presented the SEOW’s findings
on underage drinking; and Scott Schaeffer, R.Ph., of DABAT Oklahoma Poison Control Center, presented
the SEOW’s findings on nonmedical prescription drug use.
Description of SPF SIG Priorities
Based on the findings presented by the SEOW, the Collaborative endorsed that body's
recommendations and selected two SPF SIG priorities: underage drinking and prescription drug abuse.
Communities may choose one or both of the two priorities based on their own local‐level needs
assessment performed during the first six months of funding using the same process by the SEOW.
Underage Drinking
Oklahoma is consistently above the national average in alcohol‐related mortality and crime. In 2009,
39.0 percent of students in grades 9–12 reported current alcohol consumption. That percentage is
consistent with NSDUH’s data for individuals 12 years and older who reported being a current drinker,
which was 42.5 percent in 2007. Oklahoma’s adolescent binge drinking also consistently exceeds the
national average, with 2009 being the exception according to the YRBS. The SEOW was presented with
additional information when examining the persistence of the problem with underage drinking. The
YRBS showed that current alcohol use among 12th‐grade students was over 45 percent for 2009.
Although there has been a decline, nearly half of high school seniors are current drinkers, and over one‐fourth
of seniors reported binge drinking. In 2009, one quarter of 9th graders reported initiating alcohol
use before age 13. Over one in five high school seniors had ridden in a car with someone who had been
drinking, and 18.7 percent drove while drinking. Below are a sampling of possible indicators
communities may choose using the same process that the SEOW undertook, based on their needs
assessment findings:
• Past 30‐day alcohol use
• Binge drinking in the past 30 days
• Age of first use of alcohol
• Riding in a car driven by someone who has been drinking
• Driving after drinking.
Prescription Drug Abuse
In 2006, NVSS data ranked Oklahoma 4th in the Nation for fatal opioid poisonings, and in 2007, NSDUH
data showed Oklahoma was 232 percent above the national average in consumption of painkillers for
nonmedical use—a 22‐percent increase since 2004. Oklahoma has experienced a 328‐percent increase
in opiate deaths since 1999. In 2006, Oklahoma’s opiate‐related death rate was 123 percent higher than
Okla homa Department of Mental Health and Substance Abuse Services Page 27
the national average. Hospital data associated with opiates has shown a 91‐percent increase since 2003
in opiate admissions.
Below is a partial list of possible indicators for prescription drug abuse communities may choose using
the same process that the SEOW undertook, based on their needs assessment findings:
• Nonmedical use of prescription pain relievers in the past month
• Opioid overdose deaths
• Emergency room prescription drug abuse visits
• Hospital admissions for prescription drug abuse.
Okla homa Department of Mental Health and Substance Abuse Services Page 28
III. Capacity Building
Areas Needing Strengthening
While Oklahoma currently has an effective prevention system, there are areas that need strengthening.
Primarily, the prevention system will benefit from gaining the ability to: 1) build and sustain coalitions,
2) enhance understanding of how to identify or adapt strategies for specific cultures, 3) increase the
implementation of environmental strategies, and 4) build and sustain an evaluation system.
To identify areas for infrastructure improvement at both the state and community levels, ODMHSAS
conducted an infrastructure needs assessment in July 2010. State and local agency leads, ODMHSAS
staff, and community coalition members participated. Findings identified:
• Gaps in state and local partnerships,
• Workforce development needs, and
• The need for a comprehensive data warehouse with query capabilities.
Gaps in state and local partnerships included law enforcement, school boards, local education staff,
universities, businesses, media, alcohol industry, health care providers, parents, and child care
providers.
Workforce development needs included skills for coalition development and operations, engaging the
community and reaching all sectors, strategic planning, using data for decision‐making, evidence‐based
and environmental strategies, and sustainability planning.
State‐ and Community‐Level Activities
Diverse capacity building activities are being considered and planned for both the state and local
communities.
At the state level, Oklahoma government currently does not have a central location through which grant
opportunities are filtered (e.g., suggesting which agencies should apply for specific funding
opportunities as they become available). The OPLC provides a potential venue for bringing together a
broad group of prevention stakeholders to talk about how to blend funding, coordinate prevention
services, discuss state priorities—where only agency priorities previously existed—without taking away
from individual agency priorities, and come up with what the state can do to make a difference.
ODMHSAS staff or consultants trained in the SPF will be available to support the work and build the
capacity of other state systems. Providing agencies this assistance through shared training opportunities
and in‐kind embedded SPF consultants could increase their buy‐in to the process, making them more
likely to infuse the SPF into their own work. If successful, this will create a common approach and
language across systems.
In addition, other agencies are encouraged to use the SEOW as a tool to identify emerging issues and
areas of need, including treatment. ODMHSAS has a strong connection with other workgroups that
Okla homa Department of Mental Health and Substance Abuse Services Page 29
address suicide, tobacco, injury, maternal and child health, violence, and chronic disease; however,
these groups are not regularly assessing need in common or coordinated ways at this time. By formally
connecting these groups and allowing the SEOW to look at other areas (outside of substance abuse), the
state will be helping the SEOW to build its capacity while also identifying meaningful opportunities for
cross‐sector coordination.
SPF SIG technical assistance and training will be provided to the APRCs by two state prevention field
representatives, who also are responsible for monitoring the APRC contracts. These staff are trained
preventionists, with a minimum of 5 years of direct prevention experience prior to their appointment as
state field representatives.
Training and technical assistance to community coalitions will be the responsibility of the APRCs.
Through the SAPT Block Grant, the APRC staff are responsible for providing expert assistance to
community coalitions and agencies. They are also trained and certified preventionists who are
encouraged to implement strategies on behalf of the community, particularly if no coalition exists.
Oklahoma is going to use the Southwest Regional Expert Team (SWRET)—formerly the SW CAPT—for
training and technical assistance needs for its SPF SIG efforts. The state will look outside for other
sources if the SWRET is unable to provide technical assistance in an identified area, but only after
confirming the lack of availability for such assistance through the SWRET.
The Oklahoma State Department of Health provides infrastructure support for Turning Point, a
grassroots network of community coalitions throughout the state. The Turning Point coalitions are
actively engaged in determining local���level public health needs and implementing solutions to improve
community health. Many of Oklahoma’s community coalitions currently partnered with APRCs and are
implementing substance abuse prevention strategies. ODMHSAS and OSDH Turning Point have actively
collaborated to coordinate efforts where possible. Increased collaboration will be necessary when
rolling out the SPF SIG initiative as Oklahoma Turning Point also is continuing to make strides in building
community capacity through public health planning frameworks similar to the SPF. ODMHSAS will
include Turning Point regional staff in SPF staff meetings, coordinate SPF trainings at the state and
community levels with Turning Point staff, and pursue agreements to streamline messaging and project
requirements to avoid burdening coalitions potentially working on both SPF SIG and Turning Point
projects.
ODMHSAS will convene an Evidence‐Based Practices Workgroup consisting of at least five members,
including local experts, community providers, state staff, and Advisory Council members. Although
initially a SPF SIG‐funded effort, Oklahoma plans to use the Workgroup to build its capacity in using
evidence‐based practices in all its mental, emotional, and behavioral health prevention initiatives.
ODMHSAS also intends to develop: written guidelines and procedures laying out principles and
processes for the delivery of training and technical assistance from state staff to the APRCs and from the
ARPCs to the coalitions/communities they serve; systems to assess/monitor the training and technical
assistance needs of the APRCS and of coalitions; and processes for communities and the APRCs to
request training and technical assistance.
Okla homa Department of Mental Health and Substance Abuse Services Page 30
Role of the SEOW
To assist the APRCs in developing their capacity to implement the SPF process, the SEOW coordinator’s
function will evolve as the SPF SIG initiative reaches the community‐level to include a coaching role,
providing technical assistance in needs assessment and data collection. Should the SEOW coordinator
require support in this role, ODMHSAS will contract with additional resources to supply technical
assistance to communities.
The SEOW also will review community workplans to ensure communities choose strategies that logically
connect to their data, that the strategies they choose are evidence based, and that their plan’s
evaluation components test both their fidelity to process and the outcomes of the strategies they have
chosen.
ODMHSAS will make the SEOW available as a tool for other state agencies, including treatment. It is the
state’s intention that the SEOW take on myriad issues related to—but outside the boundaries of—the
state’s identified priority issues (i.e., underage drinking and prescription drug abuse), looking at epi data
not just for substance abuse, but also for mental, emotional, and behavioral disorders sharing
contributing risk factors. In this role, the SEOW will both build its capacity and assist Oklahoma in its
planning, implementation, and evaluation of quality prevention services for children, youth, and families
at the state and local levels.
Each of the agencies represented on the SEOW brings with them all available data on the populations
they serve. Despite this influx of data, the SEOW is still experiencing data gaps. To address these gaps,
the SEOW has established a workgroup whose task it is to examine the lack of data at the State and sub‐state
for certain special populations, including Native Americans, veterans, older populations, and
individuals with mental health issues, among others. The SEOW’s work on gaps in the state’s data across
populations also will include the areas identified below.
• Oklahoma Prevention Needs Assessment Survey (OPNAS)—Randomize, Weight, Disaggregate
Racial Data, and Add Tribal Affiliation
Although the state will make the OPNAS available to all schools—so that any school choosing to
participate may do so—the SEOW also will randomize and weight OPNAS data from a selected
sample. Previously, the state has faced opposition to using these data beyond a community
level; the OPNAS is a powerful instrument, and randomizing and weighting these data will help
validate survey results, making them comparable across counties and therefore allowing them
to be used in a greater capacity.
The SEOW may disaggregate data to classify “American Indian” as its own racial category within
the OPNAS responses, and to further disaggregate these data by specific tribal affiliation.
Oklahoma has the second‐largest American Indian population of any state, and having racial
data for this group would be invaluable in developing culturally competent prevention
programs, practices, and policies, and providing culturally appropriate and sensitive services to
Native populations.
Okla homa Department of Mental Health and Substance Abuse Services Page 31
• Combining existing school surveys—YRBS, OPNAS, and YTS.
Currently, Oklahoma administers the YRBS and the Youth Tobacco Survey (YTS) in schools in
odd‐numbered years, and the OPNAS in even‐numbered years. Although the YTS and YRBS are
administered in the same year, administration efforts are not combined. School participation is
challenging as a result of increasing school burden. To decrease the burden on schools and
increase the likelihood of participation in the state’s school surveys, ODMHSAS plans to work
with its SEOW to propose the coordination of the three surveys so that schools are solicited only
once every 2 years instead of annually.
• BRFSS Prescription Drugs and Illicit Drugs Modules
The BRFSS is a great source of alcohol and tobacco data, but currently does not collect data
regarding illicit and prescription drug use. Its counterpart, the YRBS, does collect illicit drug
information and in 2011 will collect prescription drug information. CSAP suggests using the
BRFSS as a data source for indicators in alcohol and tobacco, but relies on the YRBS for data on
specific drugs—yet the YRBS captures data only for high school students in grades 9–12. NSDUH
captures data on illicit drugs, reporting all illicit drugs as a single category (not by individual
drug, as is done by the YRBS), and also reports data on prescription drug use.
CSAP uses both the BRFSS and NSDUH to address indicators in alcohol and tobacco. Having both
available for illicit drug use—and the BRFSS for specific drug use—would help further identify
and address issues in the state.
• College‐Age Adult Data
Although the BRFSS includes college‐aged individuals, participants are not selected based on
college status, but as part of the population as a whole. The BRFSS is not designed to capture
data on behaviors unique to college students that are important to understanding and serving
this population. What is needed is a survey specific to college students, which collects data
pertaining to alcohol, tobacco, and other drugs; attitudes toward substance use; and risk and
protective factors affecting such use. Although some Oklahoma universities have conducted the
CORE survey and/or the College Health Assessment in the past, the implementation of such
surveys has been inconsistent. Through the SEOW, ODMHSAS plans to work with the state’s
colleges to collect data from this population on a regular basis, developing state and community
competence in addressing the unique prevention needs of college students.
• Low County Numbers
Oklahoma’s rural nature is striking and challenging. Eighty‐nine percent of cities in Oklahoma
have fewer than 3,000 residents, and approximately one‐half of Oklahoma’s 77 counties have a
population density of just 50 people per square mile. Valuable data obtained by national sources
often are unstable or unreportable at such low population levels. Aggregation of data from
multiple counties provides greater numbers and therefore greater stability; however,
Okla homa Department of Mental Health and Substance Abuse Services Page 32
aggregated counties may have more differences than similarities. Addressing this issue will be a
particular challenge for the SEOW.
• Emergency Department Data
Data from overdose deaths do not properly capture the outcomes regarding substance abuse.
Data from emergency departments would allow the SEOW to identify the broad and devastating
health consequences associated with substance abuse.
• Data Query System
Oklahoma’s existing data system (ICIS) was created originally to address the National Outcome
Measures (NOMs) identified for treatment, which focus on client‐specific data collection.
Although this system does not fit well with data collection for the population‐based prevention
NOMs, Oklahoma currently does not have an alternative for its prevention providers. To address
this challenge, ODMHSAS will work with the University of Oklahoma College of Public Health—
the state’s Block Grant evaluator—to identify systems that would be more effective for
collecting data relative to the prevention NOMs. A data query system that includes data
collected from the OPNAS would be tremendously helpful to Oklahoma’s providers, who rely
heavily on the OPNAS to serve their communities and have expressed serious interest in
acquiring a data query system to help with their efforts.
• Prescription Drug Monitoring Program (PMP) Data
Currently, PMP data are housed within the Oklahoma Bureau of Narcotics and Dangerous Drugs.
Legislation has placed significant restrictions on the ways this system may be accessed. In the
course of understanding Oklahoma’s issues with prescription drugs, this data source has been
crucial, yet the SEOW’s use of these data remains extremely limited, rendering critical data
unavailable.
• Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ)
Research has shown that LGBTQ populations are at higher risks for certain substance abuse
issues; however, data regarding these populations are unavailable in the state. Such data would
prove valuable in understanding and addressing the needs of this population, and assisting
communities and the state in developing culturally competent programs, practices, and policies.
Okla homa Department of Mental Health and Substance Abuse Services Page 33
IV. Planning
State Planning Model
The OPLC determined that no area was at higher risk than another for underage drinking, and that
insufficient data were available to determine a “hotspot” for prescription drug abuse (and therefore
justify selecting just one region for this priority issue).
Figure 11. Alcohol Use in Past Month among Persons Aged 12 to 20 in Oklahoma, by Substate Region:
Percentages, Annual Averages Based on 2006, 2007, and 2008 NSDUHs
Figure 12. Binge Alcohol Use in Past Month among Persons Aged 12 to 20 in Oklahoma, by Substate Region:
Percentages, Annual Averages Based on 2006, 2007, and 2008 NSDUHs
Okla homa Department of Mental Health and Substance Abuse Services Page 34
Figure 13. Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older in Oklahoma, by
Substate Region: Percentages, Annual Averages Based on 2006, 2007, and 2008 NSDUHs
Therefore, Oklahoma is using a hybrid equity planning model, with allocation across the state based on
both per capita and need. The model will allocate a baseline amount to each of the 17 APRCs for local
needs and capacity assessment, prioritization, and plan development. Once the submitted plan is
approved, the funding amount needed to implement that plan will be determined based on the
strategies selected and population targeted.
There are a number of reasons that a statewide allocation through the APRC system makes sense. Since
Oklahoma is primarily a rural state with only two large cities—Tulsa and Oklahoma City—the state will
have adequate funds to make an impact on the prioritized issues statewide without sacrificing the
prevention efforts in any region. In addition, by building capacity throughout the entire state, the SPF
will be sustained well beyond the grant period.
The SPF SIG is an infrastructure cooperative agreement and the APRCs are the backbone of Oklahoma’s
prevention system. Therefore, ODMHSAS plans to use its SPF SIG to build the APRCs’ capacity, with the
intention of integrating the new infrastructure into the Block Grant when the SPF SIG has ended.
Although the state plans to fund all 17 APRCs, because Cherokee Nation—awarded its own SPF SIG in
2006—has saturated 2 of the regions (APRCs), ODMHSAS may give a larger share of the SPF SIG funding
(after year 1) to the other 15.
The idea behind using an enhanced intervention site for prescription drug use comes from the literature
(Stanford cardiac study1) that suggests using a pilot site to test unproven (although theoretically
promising) strategies for prescription drugs, not knowing whether or not those strategies will work.
1 The Stanford prevention study was a cardiac study that looked at comparison communities and the importance of
looking at testing communities prior to implementing unproven strategies wholesale, even if in theory they appear
to be a good choice.
Okla homa Department of Mental Health and Substance Abuse Services Page 35
ODMHSAS plans to conduct a more intense evaluation of the enhanced site and compare the results to
another site without the enhanced intervention. The purpose is to isolate an “experimental” strategy,
try it in one community (the enhanced community), evaluate it, and then replicate it. This does not
preclude other communities from choosing to focus on prescription drug abuse, but those sites will be
limited to using the kinds of strategies currently used with alcohol and other drugs.
Community‐Based Activities
The APRCs are going to be required to conduct a thorough needs assessment at the regional level and
will have to choose one or both of the state priorities and identify the priority community or
communities with which they plan to work. Each APRC will be given the latitude to define community in
its own way (e.g., county, city, etc.). The chosen community may or may not have an existing coalition,
but if not, the APRC will be required to develop one. Different communities can be chosen by the same
APRC, and different communities can have different priorities, even if they are chosen by the same
APRC. If the APRC picks a community that has multiple coalitions, it will have to determine which of the
coalitions the project will fit, recognizing that not all coalitions might want to engage as a SPF SIG‐funded
coalition. If Oklahoma identifies a hotspot in an area where a Drug‐Free Community (DFC)
coalition exists, the APRC will consider that coalition for funding, as it should any existing coalition in a
designated hotspot.
To ensure that all SPF SIG funded interventions are evidence‐based, ODMHSAS will convene an
Evidence‐Based Practices Workgroup, as mentioned previously. The Workgroup’s role will be to utilize
CSAP’s guidance document and recommendations to clearly define criteria for Oklahoma to use when
considering the implementation of certain prevention policies, practices, or programs. Oklahoma’s
Evidence‐Based Practices Workgroup will consist of no fewer than five members representing local
experts, community providers, state staff, and OPLC members. The Workgroup also will be responsible
for reviewing community SPF SIG workplans and providing feedback and technical assistance to
community providers and coalitions on the selection, potential adaptation, and fidelity of strategies that
meet the defined evidence‐based criteria.
Allocation Approach
Oklahoma is using a hybrid equity model since statewide prevalence of underage drinking showed this
need to be universal and insufficient data existed to justify choosing a hotspot for prescription drug
abuse prevention. The state will fund each APRC directly.
The first year’s funding will be divided equally among the 17 regions. First‐year funding will be used to
hire a full‐time person in each region to work with the coalition, purchase equipment if needed (e.g., a
computer), and to accommodate local travel (e.g., mileage).
APRCs are not expected to serve the entire region. Rather, each APRC will focus on the highest need at
the community level as determined by the use of community‐level data.
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After the first year, the state will distribute money via a formula. Although this will be similar to what is
used for the SAPT Block Grant (e.g., per capita, per region, with mileage for rural communities), the
same formula will not be used because the SPF SIG communities chosen could be very different (e.g., a
rural region could choose a high‐population county and an urban area could choose a sparsely
populated community). If needed, ODMHSAS may also build in funding for lower capacity communities
versus higher capacity communities.
Each community is expected to develop its own community action plan with support and guidance from
the APRC. The plans must implement environmental strategies focused on population‐level change.
Implications of Allocation Approach
Implications of the allocation approach include
considering whether: 1) the smaller APRCs will
be able to use as much money as they are
allotted, 2) the larger metropolitan areas will
receive adequate funds to complete the grant
requirements, and 3) consumption and/or
consequences can be reduced on a state and
local level. At the state level, ODMHSAS feels it
is important each area receive enough money to
build capacity so the APRCs are able to meet the
requirements of the grant, but not so much so
that there are funds left unspent. This
consideration led to the selection of the
allocation formula described above, which takes
into account both per capita and need. By
funding all APRCs, the entire state system is
exposed to the approach, which provides the
reasonable expectation for change on both the
state and local levels.
As noted above, the Cherokee Nation of Oklahoma was previously awarded a SPF SIG cooperative
agreement. Cherokee Nation funded a number of hub communities that conducted local‐level needs
assessments, selecting as priority issues underage drinking, prescription drugs, adult alcohol misuse, and
methamphetamine use. The Tribal Jurisdictional Service Area (TJSA) is comprised of parts or all of 14
counties in northeastern Oklahoma (see map , right). The same 14 counties in the TJSA are served by 4
APRCs. ODMHSAS has worked closely with Cherokee Nation at the state/tribal government and local
levels to coordinate training, services, and community coalitions among and between service providers.
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V. Implementation
Training and Technical Assistance System
ODMHSAS has committed to the development and implementation of a workforce assessment survey.
This survey will be conducted annually, statewide, and not confined to SPF SIG subrecipients.
In addition, the state field representatives will be aware of any training and technical assistance needed
at the regional and community levels through their daily work with the APRCs. Although all communities
will follow the five‐step SPF process, individual communities may have unique strengths or areas for
enhancements. The state field representatives will bring these needs forward in weekly meetings with
ODMHSAS’s Prevention Program Manager.
Training Procedures
Oklahoma’s SPF SIG evaluator conducted statewide face‐to‐face interviews with state agency staff,
community agencies and officials (e.g., mayors, tribal leaders), and community coalitions to identify skill
development needs for the prevention workforce at both the state and community levels. At the state
level, staff identified the need for a structured, graduated approach to prevention training (i.e., taking
into account the training needs of both new and existing staff), as well as training in management and
leadership skills, ways to merge government and faith community efforts, and methods for supporting
common target populations (e.g., children, families, communities) through multiagency collaborative
efforts. At the local level, coalitions/communities identified the need for assistance in conducting
coalition operations; strategic planning; understanding data and evaluation; effectively using data for
decision‐making; understanding evidence‐based strategies; grant writing; developing strategies for
engaging community members, for changing norms, and for reaching all sectors of the community; and
planning for sustainability.
Oklahoma will require a minimum of one onsite review annually, during which technical assistance
needs for each community will be identified.
Findings from all of these approaches will be used to identify and provide trainings throughout the state.
All of the SPF SIG training opportunities will be disseminated widely and open to tribes and other agency
providers.
ODMHSAS is not going to fund coalitions directly. To avoid duplication of efforts, the state is using its
existing system of APRCs, which already work with coalitions in their regions. Working from their
knowledge of each community, the APRCs are aware of what programming and strategies are already in
place. It is Oklahoma’s goal that each of the communities use the SPF five‐step process to identify needs,
current strategies addressing those needs, and new and appropriate strategies to augment those
already being used.
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VI. Evaluation
Surveillance, Monitoring, and Evaluation Activities
At the state level, ODMHSAS has identified Bach Harrison, L.L.C., as the Project Evaluator.
Process Evaluation
Oklahoma’s SPF SIG evaluator will assess project implementation and overall state‐ and community‐level
progress using select process evaluation measures. Process information will be gathered through a
variety of methods at both the state and community levels, including a review of existing documents
and materials (e.g., the state and community SEOW data profiles and strategic plans, minutes from
project meetings), participation and observations at project meetings, and interviews with project
stakeholders.
Outcome Evaluation
Oklahoma’s evaluator also will assess outcomes at the state and community levels in two overarching
areas: (1) prevention capacity, and (2) priority substance abuse problems.
To assess prevention capacity, Bach‐Harrison will primarily use the stakeholder interviews (with state‐level
project members and community coalition members) discussed above to document changes in
prevention infrastructure and capacity at the state and community levels (including coalitions’ and
member agencies’ capacities). The interviews will be organized around the SPF steps and will place a
particular emphasis on documenting and assessing project capacity‐building activities and
enhancements that correspond to the five steps (e.g., improvements in needs assessment and strategic
planning capacities).
To assess the project’s progress on preventing and reducing underage drinking and prescription drug
abuse, Bach‐Harrison will collect survey data annually and acquire archival data on an ongoing basis
from a variety of state sources and publicly available national sources.
In addition to assessing changes in the priority outcomes, Oklahoma’s SPF SIG evaluator will examine the
intervening variables (causal factors) associated with these ultimate outcomes. The survey and archival
data also will be sources of data for intervening variables.
Tracking
The state’s evaluator will track both process and outcome data. Process data will include demographics
of the population served, number and type of strategies implemented, implementation of the SPF steps,
facilitators of and barriers to project progress, and contextual factors that may affect project progress
and outcomes. The SPF SIG evaluator will use ODMHSAS’s system, ICIS, to collect process data.
Oklahoma has used ICIS as its local reporting and monitoring system for the SAPT Block Grant and has
satisfied all Federal reporting requirements without issue. As part of the cross‐site evaluation, data will
also be collected through the GLI, CLI, and fidelity instruments.
Okla homa Department of Mental Health and Substance Abuse Services Page 39
Outcome data for underage drinking will include past 30‐day alcohol use, binge drinking in the past 30
days, age of first use of alcohol, riding in a car driven by someone who has been drinking, and driving
after drinking. Outcome data for prescription drug abuse will include nonmedical use of prescription
pain relievers in the past month, opioid overdose deaths, emergency room prescription drug abuse
visits, and hospital admissions for prescription drug abuse.
Expected Change
Bach‐Harrison will examine state and community measures to determine if the SPF SIG initiative is linked
to an increase in prevention capacity and lower levels of underage drinking, prescription drug abuse,
and targeted intervening variables. Due to the concentration of SPF resources in the selected
communities, Oklahoma’s evaluator anticipates that SPF effects on community‐level outcomes will be
more pronounced than state‐level outcomes.
NOMs Collection and Submission
The state’s evaluator will use ICIS to collect required NOMs, such as the number of persons served by
age, gender, race, and ethnicity, and total number of evidence‐based programs, policies, and practices.
The evaluator will submit the data electronically twice a year through the CSAP Data Coordination and
Consolidation Center Services Accountability and Monitoring System (DCCC‐CSAMS).
Okla homa Department of Mental Health and Substance Abuse Services Page 40
VII. Cross‐Cutting Components and Challenges
Cultural Competence
In their workplans, the APRCs will be required to indicate how they will be culturally competent, and to
demonstrate inclusion of the coalitions with which they work. Evidence‐based practices workgroup
members will be responsible for confirming that the strategies match the community they expect to
serve, identifying the modifications that can be made, and determining whether those are appropriate
for the targeted population. Environmental approaches are more difficult to adapt and ensure they are
culturally competent. ODMHSAS’s tribal liaison—who is also the Systems of Care Cultural Competency
Advisor—is written in‐kind in SPF SIG to serve as the cultural competence advisor to the SPF.
The state does intend to contract for cultural competence training to the APRCs. ODMHSAS will
purchase or examine tools for providers to help with their development in this area. One example
already in use is Culture Vision, a Web‐based tool for health care that advises providers on the
backgrounds of different populations and general expectations for the different cultures in terms of
health. Oklahoma will look into the viability of adding a prevention module to Culture Vision, and
perhaps may be able to add individual tribes to the tool as well, since Oklahoma is home to 45 distinct
tribes.
Sustainability
Oklahoma’s SAPT Block Grant is on a 5‐year funding cycle. ODMHSAS is considering logistical revisions to
its contracting methods that would help align the SPF SIG and the Block Grant, keeping the initiative
within the same agency throughout the duration of the project. The review committee, which includes
the SEOW, will review all bids, and annually or semiannually review community workplans, involving
more experts in the process. The experts will be responsible for providing the technical assistance
needed to develop the workplans (e.g., SEOW members will provide technical assistance on data
collection and analysis).
Combining Block Grant and SPF SIG efforts will include, eventually, fully integrating the contracting and
SPF processes, and ultimately aligning all prevention efforts with the SPF. The SPF will guide the
approval of state and community strategies, with the review of community workplans asking: Is the
strategy sustainable? How will it be sustained? If communities have to develop coalitions, how are the
coalitions going to be sustained?
The state infrastructure assessment identified areas where Oklahoma will be making improvements for
the long term. Because the state is able to budget the Block Grant for a longer time (than the SPF SIG),
ODMHSAS will fund only those SPF initiatives that reasonably can be sustained by the Block Grant once
the SPF SIG funding has ended.
Every community action plan will be required to include both an evaluation and a sustainability plan.
Communities will receive training on these elements.
Okla homa Department of Mental Health and Substance Abuse Services Page 41
The state purposely developed both its SEOW and the OPLC to continue after the SPF SIG initiatives have
been completed. As stated earlier, the OPLC was established to promote the coordinated planning,
implementation, and evaluation of quality prevention services for children, youth, and families at the
state and local levels. As the state’s focus intensifies on mental, emotional, and behavioral health
disorders as related problems, this council will broaden its focus on state prevention priorities and
coordination among state agencies on prevention services. The same is true for the SEOW, which will
continue to collect and analyze relevant state, tribal, and local data to guide substance use prevention
planning, programming, and evaluation, but will be available to work on any mental, emotional, or
behavioral disorder issue.
Challenges
Needs‐based Allocation
Oklahoma’s data are not sufficient to justify on the allocation of funds on purely a needs‐based process.
As mentioned previously, underage drinking is prevalent statewide, and insufficient data are available to
determine particular hotspots for the nonmedical use of prescription drugs. Communities wishing to
address the latter issues will likely face some challenges concerning data. The literature on prescription
drug use is limited, which will challenge communities to come up with strategies. A lot of data sources
that include prescription drugs combine all drugs for singular reporting, rather than reporting on
prescription drugs as a single class.
The state will have two cycles of prescription drug use data. OPNA collected prescription drug data in
2010 and YRBS will provide prescription drug use data in 2011. Communities currently have local‐level
comparison data from the OPNA that is unavailable at the state level.
Through its proposed enhanced intervention community, Oklahoma hopes to add prescription drug
abuse prevention strategies to the Federal registry of effective and promising practices. If sufficient data
surfaces from evaluation of the enhanced community demonstrating positive outcomes, those
strategies may be considered for service‐to‐science submission.
Implementation of Plan
During the most recent Block Grant bidding cycle, Oklahoma designed a workplan template that aligns
with the SPF, so the APRCs already are familiar with the process. The APRCs also are preventionists who
can implement strategies if need be, in addition to providing technical assistance to coalitions. Under
the upcoming bid, the state will hold the APRCs accountable for building organizational capacity within
coalitions. This will be a challenge for the APRCs on two levels: many of the state’s coalitions may not
yet have the capacity to implement the SPF, and not all coalitions may want to engage in the SPF
process.
One final challenge ODMHSAS expects to encounter in the planning process is communities’ desire to
jump straight to strategies after identifying their priority issues. Oklahoma communities understand why
identifying priorities is necessary, but continue to require assistance to understand the importance of
Okla homa Department of Mental Health and Substance Abuse Services Page 42
identifying intervening variables and targeting strategies to these risk or causal factors to have an impact
on their identified problem behaviors.
Okla homa Department of Mental Health and Substance Abuse Services Page 43
Appendices
Okla homa Department of Mental Health and Substance Abuse Services Page 44
OPLC Membership
Member/Delegate Name AFFILIATION
Secretary Terri White Office of Governor
Pending Appointment Senate Member
Representative McCullough House of Representatives Member
Steve Buck Department of Mental Health & Substance Abuse Services
Kevin Ward Department of Public Safety/Highway Safety Office
Dr. Lynn Mitchell State Department of Health
Howard Hendrick Department of Human Services
Michael Fogarty Health Care Authority
Darrell Weaver Oklahoma Bureau of Narcotics
Sandy Garrett Oklahoma Department of Education
Lisa Smith Oklahoma Commission on Children and Youth
Linda Terrell Oklahoma Institute for Child Advocacy
Lt. Kerri Keck Oklahoma National Guard
Stacy Potter Community‐level Prevention Provider
Dr. BJ Boyd Tribal Behavioral Health
Jane Goble‐Clark Prevention Advisor
Sheila Groves State PTA
Stacey Puckett Oklahoma Chiefs of Police Association
Chancellor Glen Johnson Higher Education
Robert E. Gene Christian Office of Juvenile Affairs
Robin Jones Office of Faith‐Based Initiatives
Dr. Don Baker Prevention Researcher
Okla homa Department of Mental Health and Substance Abuse Services Page 45
SEOW Membership2
Member/Delegate Name Affiliation
Anthony Kibble Oklahoma Commission on Children and Youth
Leslie Ballinger Southwest Regional Expert Team—Epidemiology Consultant
Cortney Yarholar Oklahoma Department of Mental Health and Substance Abuse
Services—Transformation Agency/Tribal Liaison
Connie Schlittler Oklahoma Department of Human Services
David Wright Oklahoma Department of Mental Health and Substance Abuse
Services—Decision Support Services
Courtney Charish Oklahoma Department of Corrections—Statistical Analyst
Stacey Puckett Oklahoma Association of Police Chiefs
Dr. Misty Boyd Cherokee Nation Behavioral Health Services
Patti Shook Osage Nation Prevention Program
Captain Rusty Rhoades Oklahoma Highway Patrol/Department of Public Safety
Derek Pate Oklahoma State Department of Health—Health Care Information
Donald Baker University of Oklahoma, Anne and Henry Zarrow School of Social Work
—Director
Dough Matheny Oklahoma State Department of Health, Department Tobacco
Prevention Service—Chief
Dr. J.C. Smith Oklahoma State Department of Education
Dr. Lee McGoodwin Oklahoma Poison Control Center—Managing Director
Erin Meyer Oklahoma Health Care Authority
Jamie Piatt Oklahoma Department of Mental Health and Substance Abuse
Services—Epidemiologist/SEOW Coordinator
Jessica Hawkins Oklahoma Department of Mental Health and Substance Abuse
Services—Prevention Services Director
Young Onuorah Oklahoma Department of Mental Health and Substance Abuse
Services—Prevention Program Manager
Joyce Morris Oklahoma State Department of Health Tobacco Use Prevention—State
Assessment Coordinator
Scott Schaeffer University of Oklahoma Health Sciences Center
John Hudgens Oklahoma Department of Mental health and Substance Abuse Services‐
Innovation Center Director
Sydney Martinez Oklahoma Tribal Epidemiology Center
Captain Chin U Kim
Oklahoma Air National Guard—Drug Demand Reduction Administrator
Lisa Barnes Wichita Mountain Prevention Network—Executive Director
Liz Langthorn Oklahoma Department of Health—Injury Prevention
Dr. Barbara Masters Oklahoma Veterans Affairs
Patty Martin Bach Harrison LLC—Project Evaluator
2 Unless identified as support or consultant, all are voting members.
Okla homa Department of Mental Health and Substance Abuse Services Page 46
Rashi Shukla University of Central Oklahoma—Department of Sociology
Scott Schaeffer Oklahoma Poison Control Center—Assistant Managing Director
Shannon Rios Oklahoma Department of Human Services—Research Manager
Sheryll Brown Oklahoma State Department of Health—Director of Violence
Prevention Programs
Don Vogt Oklahoma Bureau of Narcotics
Stephanie U’Ren Oklahoma Department of Mental Health and Substance Abuse
Services—Community Partnership Manager
Samuel McClendon Oklahoma Department of Mental Health and Substance Abuse
Services—Prevention Field Representative
Joy Hermansen Oklahoma Department of Mental Health and Substance Abuse
Services—Prevention Field Representative
Okla homa Department of Mental Health and Substance Abuse Services Page 47
Regional Network Map
Okla homa Department of Mental Health and Substance Abuse Services Page 48
Epidemiological Data Sources
Alcohol Epidemiologic Data System (AEDS) • AEDS is responsible for maintaining, and extending an
alcohol‐related epidemiologic databank. AEDS also compiles the Alcohol Epidemiologic Data Directory
which is a current listing of surveys and other relevant data suitable for epidemiologic research on
alcohol.
Behavioral Risk Factor Surveillance Survey (BRFSS) • Established in 1984 by the Centers for Disease
Control and Prevention (CDC), the Behavioral Risk Factor Surveillance System (BRFSS) is a state‐based
system of health surveys that collects information on health risk behaviors, preventive health practices,
and health care access primarily related to chronic disease and injury. For many states, the BRFSS is the
only available source of timely, accurate data on health‐related behaviors. Oklahoma has participated in
BRFSS since 1995. This report focused on 2007 BRFSS data to give a current picture of substance
use/abuse in Oklahoma. http://www.cdc.gov/brfss/about.htm
Bureau of Justice • The Bureau of Justice Statistics was first established on December 27, 1979 under
the Justice Systems Improvement Act of 1979. The Bureau of Justice Statistics (BJS) is a component of
the Office of Justice Programs in the U.S. Department of Justice.
Center for Disease Control and Prevention (CDC) • The CDC, a part of the U.S. Department of Health
and Human Services, is the primary Federal agency for conducting and supporting public health activities
in the United States. CDC’s focus is not only on scientific excellence but also on the essential spirit that is
CDC – to protect the health of all people. CDC keeps humanity at the forefront of its mission to ensure
health protection through promotion, prevention, and preparedness.
Fatal Analysis Reporting System (FARS) • FARS contains data on all fatal traffic crashes within the 50
states, the District of Columbia, and Puerto Rico. The data system was conceived, designed, and
developed by the National Center for Statistics and Analysis (NCSA) to assist the traffic safety
community in identifying traffic safety problems, developing and implementing vehicle and driver
countermeasures, and evaluating motor vehicle safety standards and highway safety initiatives.
National Survey on Drug Use and Health (NSDUH) • The National Survey on Drug Use and Health
(NSDUH) provides annual data on drug use in the United States. The NSDUH is sponsored by the
Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Public
Health Service and a part of the Department of Health and Human Services (DHHS). The survey provides
yearly national and state‐level estimates of alcohol, tobacco, illicit drug, and non‐medical prescription
drug use. Other health‐related questions also appear from year to year, including questions about
mental health. The NSDUH findings were used to evaluate substance use/abuse from the age of 12. This
survey is not a school based survey so it provides a different perspective than the YRBS for youth.
https://nsduhweb.rti.org
National Vital Statistics System (NVSS) • The National Vital Statistics System is the oldest and most
successful example of inter‐governmental data sharing in Public Health and the shared relationships,
standards, and procedures form the mechanism by which NCHS collects and disseminates the Nation's
Okla homa Department of Mental Health and Substance Abuse Services Page 49
official vital statistics. These data are provided through contracts between NCHS and vital registration
systems operated in the various jurisdictions legally responsible for the registration of vital events –
births, deaths, marriages, divorces, and fetal deaths.
Oklahoma Bureau of Narcotics and Dangerous Drugs (OBN) • The Oklahoma State Bureau of Narcotics
and Dangerous Drugs Control is a law enforcement agency with a goal of minimizing the abuse of
controlled substances through law enforcement measures directed primarily at drug trafficking, illicit
drug manufacturing, and major suppliers of illicit drugs.
Oklahoma Department of Corrections (ODOC) • Following the enacting of the Oklahoma Corrections
Act of 1967, the new Department of Corrections was created on July 1, 1967. The ODOC is a network of
facilities comprised of 17 institutions, seven Community Corrections Centers, and 15 Community Work
Centers. The incarcerated women data was obtained from the ODOC.
Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) • The ODMHSAS
was established in 1953 and continues to evolve to meet the needs of all Oklahomans. Collaborating
with leaders from multiple state agencies, advocacy organizations, consumers and family members,
providers, community leaders and elected officials, the way has been paved for meaningful mental
health and substance abuse services transformation in Oklahoma. The ODMHSAS is responsible for
providing services to Oklahomans who are affected by mental illness and substance abuse.
Oklahoma Prevention Needs Assessment Survey (OPNA) • The Oklahoma Prevention Needs As‐sessment
is a paper/pencil survey administered in opposite years of the YRBS in schools to 6th, 8th, 10th
and 12th grade students. The survey is designed to assess students’ involvement in a specific set of
problem behaviors, as well as their exposure to a set of scientifically validated risk and protective
factors. In 2008, 60,720 students were surveyed from 686 schools across 74 of Oklahoma’s 77 counties.*
The major limitation of this survey is that it is not a random sample; schools choose whether or not they
participate, making it a convenience sample.
Oklahoma State Bureau of Investigation (OSBI) • The Oklahoma State Bureau of Investigation Uniform
Crime Reporting (UCR) Program is part of a nationwide, cooperative statistical effort.
Oklahoma State Department of Health (OSDH) • The OSDH is a department of the government of
Oklahoma responsible for protecting the health of all Oklahomans and providing other essential human
services and through its system of local health services delivery, is ultimately responsible for protecting
and improving the public’s health status through strategies that focus on preventing disease. The OSDH
serves as the primary public health protection agency in the state.
Oklahoma Tax Commission • Since 1931, the Oklahoma Tax Commission has held the responsibility of
the collection and administration of taxes, licenses and fees that impact every Oklahoman. Under the
direction of the state legislature, the Tax Commission manages not only the collection of taxes and fees,
but also the distribution and apportionment of revenues to various state funds. The collected revenues
fuel such state projects as education, transportation, recreation, social welfare and a myriad of other
services.
Okla homa Department of Mental Health and Substance Abuse Services Page 50
Oklahoma Violent Death Reporting System (OKVDRS) • Oklahoma and 16 other states (Massachusetts,
Maryland, New Jersey, Oregon, South Carolina, North Carolina, Virginia, Alaska, Colorado, Georgia,
Wisconsin, Rhode Island, Kentucky, Utah, New Mexico and California) participate in the National Violent
Death Reporting System. Violent deaths include homicides, suicides, deaths from legal intervention,
unintentional firearm deaths, deaths of undetermined manner and deaths from acts of terrorism. Data
for OKVDRS are collected from death certificates, medical examiner reports, police reports, supple‐mental
homicide reports and crime labs. Standardized methodology and coding are used to collect the
data and enter into a database that is housed at the Oklahoma State Department of Health (OSDH). The
OSDH partners with the Oklahoma State Bureau of Investigation and the Oklahoma Medical Examiner’s
Office to collect the data.
Oklahoma Youth Tobacco Survey (OYTS) • Designed to provide comprehensive data for planning and
evaluating progress toward reducing tobacco use among youth. Items measured as part of the OYTS
survey include correlates of tobacco use such as demographics, minors’ access to tobacco, and exposure
to secondhand smoke. It provides data representative of Oklahoma middle school and high school
youth’s tobacco‐related beliefs, attitudes and behaviors, and exposure to pro‐ and anti‐tobacco
influences such as curricula and media. The data can be compared to results from the National Youth
Tobacco Survey and results from other states.
Pacific Institute for Research and Evaluation (PIRE) • PIRE is one of the Nation’s preeminent inde‐pendent,
nonprofit organizations focusing on individual and social problems associated with the use of
alcohol and other drugs. PIRE is dedicated to merging scientific knowledge and proven practice to create
solutions that improve the health, safety, and well‐being of individuals, communities, nations, and the
world.
Pregnancy Risk Assessment Monitoring System (PRAMS) • PRAMS was initiated in 1987 with a goal to
improve the health of mothers and infants by reducing adverse outcomes such as low birth weight,
infant mortality and morbidity, and maternal morbidity. PRAMS provides state‐specific data for planning
and assessing health programs and for describing maternal experiences that may contribute to maternal
and infant health.
Smoking Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) • SAMMEC is an internet‐based,
computational application. SAMMEC calculates annual state‐ and national‐level smoking‐attributable
deaths and years of potential life lost for adults and infants in the United States. The Adult
application also calculates medical expenditures and productivity costs among adults. Likewise,
Maternal and Child Health (MCH) SAMMEC estimates annual state‐ and national‐level smoking‐attributable
deaths and years of potential life lost for infants.
Substance Abuse and Mental Health Services Administration (SAMHSA) • The Substance Abuse and
Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human
Services (HHS), focuses attention, programs and funding on promoting a life in the community with jobs,
homes and meaningful relationships with family and friends for people with or at risk for mental or
Okla homa Department of Mental Health and Substance Abuse Services Page 51
substance use disorders. The Agency is achieving that vision through an action‐oriented, measurable
mission of building resilience and facilitating recovery.
The Uniform Crime Report (UCR) • The UCR was conceived, developed, and implemented by law en‐forcement
for the express purpose of serving as a tool for operational and administrative purposes.
Under the auspices of the International Association of Chiefs of Police, the UCR Program was developed
in 1930. Prior to that date, no comprehensive system of crime information on a national scale existed.
The Oklahoma State Bureau of Investigation assumed the statewide administration of the UCR Program
on September 1, 1973. Statistical information was collected and compiled through the year 2007 with a
comparative analysis of the years 2006 and 2005.
United States Census Bureau • The Census Bureau serves as the leading source of quality data about
the Nation’s people and economy. The bureau of the Commerce Department, responsible for taking the
census, provides demographic information and analyses about the population of the United States.
Census data was used for all Oklahoma demographics.
http://www.census.gov/main/www/aboutus.html
Youth Risk Factor Behavioral Survey (YRBS) • The Youth Risk Behavior Surveillance System (YRBSS)
monitors six categories of priority health‐risk behaviors among youth and young adults, including
behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug
use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs),
including human immunodeficiency virus (HIV) infections; unhealthy dietary behaviors; and physical
inactivity. YRBSS includes a national school‐based survey conducted by CDC and state and local school‐based
surveys conducted by state and local education and health agencies. Oklahoma has participated
in the YRBS since 2003.
Okla homa Department of Mental Health and Substance Abuse Services Page 52
Timelines and Milestones
Activity
Date Agency Responsible
RFP released
January 2011 ODMHSAS
Proposals submitted
February 2011 APRC
Proposals reviewed and approved
February 2011 ODMHSAS
Awards made
March 2011 ODMHSAS
Start date
April 1, 2011 APRC
Subrecipient staff hired May 1, 2011 APRC
Technical assistance on developing a workplan using
the SPF model
May–November 2011
ODMHSAS
Workplans developed
May–November 2011 APRC
Workplans submitted
November 30, 2011 APRC
Workplans reviewed and approved
December 31, 2011 ODMHSAS
Implementation start date
January 1, 2012 APRC
Okla homa Department of Mental Health and Substance Abuse Services Page 53
References
1. Centers for Disease Control and Prevention (CDC). 2003–2009 Youth Risk Behavior Survey. Access:
www.cdc.gov/yrbss
2. CDC. Behavioral Risk Factor Surveillance System Survey Data [2003‐2009]. Atlanta, Georgia: CDC.
3. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National
Survey on Drug Use and Health,[2003–2007]. Rockville, MD: SAMHSA/OAS.
4. CDC. Pregnancy Risk Assessment Monitoring System [2003–2007]. Access:
http://www.cdc.gov/prams/CPONDER.htm
5. Hoyert, D. L., Heron, M. P., Murphy, S. L., et.al. (2006). “Deaths: Final Causes for 2003.” Division of
Vital Statistics Reports, 54(13).
6. Kung, H. C., Hoyert, D. L., Xu, J., et.al. (2008). “Deaths: Final Causes for 2005.” Division of Vital
Statistics Reports, 56(10).
7. Minino, A. M., Heron, M. P., Murphy, S. L., et al. (2007). “Deaths: Final Causes for 2004.” Division of
Vital Statistics Reports, (55)19.
8. U.S. Department of Justice, Federal Bureau of Investigation. Uniform Crime Reporting Program
Data, 2003–2009.
9. National Highway Traffic Safety Administration. Fatality Analysis Reporting System 2003–2008.
Washington, D.C.: Department of Transportation, National Highway Traffic Safety Administration.
10. Heron, M. P. “Deaths; Leading Causes for 2006.” (2009). National Vital Statistics Reports, 57(14).
11. Oklahoma State Department of Health, Health Care Information Division. Oklahoma Hospital
Inpatient Data 2003–2008. Hospitalizations associated with Opiates ICD9 Code 965.0.
12. Warner, M., Chen, L. H., Makuc, D. M. (2009). “Increase in fatal poisonings involving opioid
analgesics in the United States, 1999–2006.” NCHS Data Brief, Number 22. Hyattsville, MD: National
Center for Health Statistics.
13. Oklahoma Department of Mental Health and Substance Abuse Services. Oklahoma’s State Plan on
Aging, 2007–2010.
14. Oklahoma City Heartline. Call Volume Quarter 1, 2008–2010.
15. Oklahoma State Department of Health. Injury Prevention Service. Summary of Violent Deaths in
Oklahoma: Oklahoma Violent Death Reporting System, 2004–2007.
16. Oklahoma Department of Mental Health and Substance Abuse Services. Statistics. Access:
http://www.ok.gov/odmhsas/Statistics_and_Data/Statistics/
17. Oklahoma Systems of Care Wraparound Initiative. Youth Enrolled. Fiscal Years 2006–2010.
18. Oklahoma Department of Mental Health and Substance Abuse Services. Oklahoma State
Epidemiological Outcomes Workgroup. 2009 Epidemiological Profile

Okla homa Department of Mental Health and Substance Abuse Services Page 1
Oklahoma Strategic Plan for the Prevention of
Mental, Emotional, and Behavioral Disorders
2010
Okla homa Department of Mental Health and Substance Abuse Services Page 2
Foreword
In July 2009, the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS)
was awarded a Strategic Prevention Framework State Incentive Grant (SPF SIG) by the Substance Abuse
and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP).
One of the central requirements of the SPF SIG is to develop a state substance abuse prevention
plan using the Strategic Prevention Framework (SPF) model.
While the Oklahoma Strategic Plan for the Prevention of Mental, Emotional, and Behavioral Disorders
will act as the state’s roadmap for its SPF SIG initiatives, it is intended for a larger purpose,
encompassing Oklahoma’s vision for building a strong prevention infrastructure for a broad array of
related mental, emotional, and behavioral disorders. The Plan reflects statewide input from community
representatives and experts in substance abuse and related fields who participated in the planning
process. The Plan provides clear direction and common ground for future endeavors addressing the
prevention of substance abuse, the prevention of mental illness, and mental health promotion.
The commitment and cooperation of those involved in the planning process for the Oklahoma Strategic
Plan is unprecedented. It speaks to the gravity of mental, emotional, and behavioral disorder issues in
our communities. Oklahoma’s Strategic Plan provides the opportunity to initiate collective action among
diverse groups and restore and strengthen our youth, families, and communities.
Terri White
Commissioner, Oklahoma Department of Mental Health and Substance Abuse Services
Secretary of Health
Okla homa Department of Mental Health and Substance Abuse Services Page 3
Table of Contents
I. Background
State Incentive Cooperative Agreement (SICA) ................................................................................4
Mission .............................................................................................................................................4
Vision ................................................................................................................................................4
Goals .................................................................................................................................................4
Oklahoma Logic Model ......................................................................................................................5
Theoretical Framework .....................................................................................................................6
II. Assessment
Assessing the Problem ......................................................................................................................9
Assessing the Current Prevention System (Capacity and Infrastructure) ...................................... 20
Criteria and Rationale for SPF SIG Priorities ................................................................................... 22
Description of SPF SIG Priorities ..................................................................................................... 26
III. Capacity Building
Areas Needing Strengthening ........................................................................................................ 28
State‐ and Community‐level Activities ........................................................................................... 28
Role of the SEOW ........................................................................................................................... 30
IV. Planning
State Planning Model ..................................................................................................................... 33
Community‐based Activities........................................................................................................... 35
Allocation Approach ....................................................................................................................... 35
Implications of Allocation Approach .............................................................................................. 36
V. Implementation
Training and Technical Assistance System ..................................................................................... 37
Training Procedures ....................................................................................................................... 37
VI. Evaluation
Surveillance, Monitoring, and Evaluation Activities ....................................................................... 38
Process Evaluation......................................................................................................................... 38
Outcome Evaluation ....................................................................................................................... 38
Tracking ......................................................................................................................................... 38
Expected Change ............................................................................................................................ 39
NOMs Collection and Submission .................................................................................................. 39
VII. Cross‐Cutting Components and Challenges
Cultural Competence ...................................................................................................................... 40
Sustainability ................................................................................................................................. 40
Challenges ..................................................................................................................................... 41
Appendices
Oklahoma Prevention Leadership Collaborative Membership ..................................................................... 44
State Epidemiological Outcomes Workgroup Membership ......................................................................... 45
Regional Area Prevention Resource Center Network Map .......................................................................... 47
Epidemiological Data Sources ....................................................................................................................... 48
SPF SIG Timeline and Milestones .................................................................................................................. 52
References ................................................................................................................................................... 53
Epidemiological Data Tables ......................................................................................................................... 54
Formula Example—Scoring Analyses of the Prescription Drug Substance Category ................................... 61
Okla homa Department of Mental Health and Substance Abuse Services Page 4
I. Background
State Infrastructure Cooperative Agreement (SICA)
A state substance abuse prevention plan was developed in 2005 as a result of Oklahoma’s previous
infrastructure cooperative agreement with SAMHSA/CSAP known as the State Incentive Cooperative
Agreement, or SICA. Several significant improvements in the state’s prevention service delivery system
were made as a result of this past assessment and planning effort, including the adoption of a SPF‐based
community workplan utilized by providers, development of the Oklahoma Prevention Needs Assessment
survey, and a commitment to fund evidence‐based prevention practices.
Like SICA, the SPF SIG is an infrastructure cooperative agreement aimed at changing the way that
prevention is implemented in Oklahoma. SAMHSA conceived the SPF as a process through which all
state prevention resources may be aligned and performance of the substance abuse prevention portion
of the SAPT Block Grant organized and managed. Oklahoma will use its SPF SIG funding to develop an
infrastructure that supports bringing together multiple funding streams from multiple sources with the
common goal of creating and sustaining a community‐ and evidence‐based approach to substance abuse
and mental illness prevention and mental health promotion.
Mission
The mission of this Strategic Plan is to implement and sustain comprehensive, statewide prevention
efforts that are evidence‐based and accountable to the state’s citizens, encourage the collaboration of
multiple agencies and organizations, and enhance the capacity of communities to provide an effective
and comprehensive system of prevention services reflective of community needs and resources.
Vision
The Strategic Plan provides a vision of a future for Oklahoma in which every citizen is provided the
opportunity to achieve a state of health and well‐being free from the scourge of mental, emotional, and
behavioral disorders.
Goals
1) Prevent the onset and prevent/reduce the problems associated with the use of alcohol, tobacco,
and other drugs across the lifespan as identified and measured using epidemiological data.
2) Prevent the onset and prevent/reduce the problems associated with mental and emotional
disorders as identified and measured using epidemiological data.
3) Use the SPF process to create prevention‐capable communities where individuals, families, schools,
workplaces, communities, and the state have the capacity and infrastructure to prevent substance
abuse and mental illness.
4) Develop systematic processes to collect and analyze data regularly to accurately assess the causes
and consequences of alcohol and other drug use.
5) Develop data‐driven decision methods to use prevention resources effectively.
Okla homa Department of Mental Health and Substance Abuse Services Page 5
6) Increase the use of prevention services that are evidence‐based, implemented with fidelity, and
evaluated for effectiveness.
7) Increase the capacity of prevention providers to meet the behavioral health prevention needs of
diverse individuals and communities in a timely, culturally competent manner.
8) Actively seek opportunities to collaborate and coordinate prevention efforts and resources across
sectors to achieve significant, population‐level behavioral health outcomes.
Oklahoma Logic Model
To prevent the onset and prevent/reduce the problems associated with the use of alcohol, tobacco, and
other drugs across the lifespan, Oklahoma will work from a theory of change that is supported through
research. Research has shown changing population behavior requires targeting resources to issues
influencing that behavior (intervening variables, or risk or causal factors). Once these issues have been
identified, a comprehensive set of state and community evidence‐based strategies can be selected and
employed. It also is important to evaluate the effectiveness of the state and community efforts at each
phase through process, immediate, intermediate, and long‐term outcome data collection.
NEEDS ASSESSMENT
PLANNING
State
Strategies
State
Workplan
Community
Strategies
Community
Workplan
EVALUATION
Impact Long‐Term
Outcomes
Intermediate
Outcomes
Immediate
Outcomes
Process
Measures
Consumption
Intervening
Variables
Risk/Causal
Factors
Consequence
Okla homa Department of Mental Health and Substance Abuse Services Page 6
Theoretical Model
Conceptual and theoretical approaches to prevention rest on a number of assumptions. First,
prevention is viewed as a proactive process by which conditions that promote well‐being are created.
Prevention activities empower individuals and communities to meet the challenges of life events and
transitions by creating conditions and reinforcing individual and collective behaviors that lead to healthy
communities and lifestyles.
Second, prevention requires multiple processes on multiple levels to protect, enhance, and restore the
health and well‐being of communities and the state. State departments and community organizations
may emphasize a number of different processes in seeking to realize the goals of the Oklahoma
Strategic Plan—all with very little overlap or duplication. Although their focus on and approach to
prevention may differ—as mandated by funding and regulatory sources—they may share similar
processes and elements, such as needs assessment activities and the development and nurturing of
community collaboratives, which can be strengthened through communication and coordination.
Third, prevention is based on the understanding that there are risk and protective factors that vary
among individuals, age groups, racial and ethnic groups, communities, and geographic areas. Theories,
models, and data that allow for the explanation and understanding of risk and protective factors at
several levels of social aggregation—community, school, peers, family, and the individual’s
characteristics—provide a rational approach to designing prevention strategies and programs. The
Hawkins and Catalano risk and protective factors model is the conceptual approach currently practiced
within the Oklahoma State Department of Mental Health and Substance Abuse Services and provides
the framework for conceptualizing prevention efforts within the Oklahoma Strategic Plan.
Risk factors exist in clusters rather than in isolation. For example, children who suffer abuse or neglect
frequently are found in single‐parent families of low socioeconomic status living in disadvantaged
neighborhoods inundated with violence, drug use, and crime. Research has shown that multiple risk
factors have a synergistic effect (i.e., the interactions between these risk factors have a greater effect
than any single risk factor produces alone). Therefore, the more risk factors a child is exposed to, the
greater the likelihood that he or she will, for example, use drugs, become violent, or engage in criminal
behavior.
However, Oklahoma understands that achieving significant, population‐based behavior change requires
more than just making a positive impact on the underlying conditions (i.e., risk and protective factors); it
requires significant and measurable reductions in the causal factors related to mental, emotional, and
behavioral disorders.
The idea of multiple influences affecting behavioral outcomes is evident in the causal factor research
conducted by the Pacific Institute for Research and Evaluation (PIRE). PIRE has identified seven causal
factors or areas of intervention that can make drug using behaviors—and therefore the profusion of
health, social, and economic problems related to drug use—more or less likely to occur.
Economic availability (accessibility according to price), retail availability (accessibility from retail
Okla homa Department of Mental Health and Substance Abuse Services Page 7
sources), and social availability (accessibility from nonretail sources, such as family and friends) are key
areas of influence, since without availability there can be no substance use and no associated problems.
Promotion—alcohol and tobacco manufacturers’ and retailers’ attempts to increase demand through
the advertising and promotion of their products—is another identified causal factor. Community norms
regarding the acceptability of high‐risk behaviors, including substance use, may be codified into concrete
expressions such as public policies, laws, and regulations. In addition to directly defining undesired
illegal substance use, these community norms can affect other areas of intervention (e.g., availability
and promotion), shaping both demand and supply. The degree to which laws and regulations limit
availability, regulate promotion, or reduce undesired use is directly related to their enforcement. Finally,
individual characteristics—genetics, values, attitudes, and social associations—also contribute to
individual substance use decisions.
Oklahoma’s commitment to the risk and protective factor model is in alignment with PIRE’s causal factor
model, which represents a public health approach to prevention and emphasizes prevention effects at
the community level. Oklahoma appreciates that communities are complex systems with complicated
and shifting interactions among and between their parts, and recognizes that preventing mental,
emotional, and behavioral disorders requires a comprehensive, systematic approach based on a clear
understanding of each contributing causal factor and the relationship between those factors. Knowing
how—and where—to effectively intervene is essential to achieving population outcomes.
The SPF model also employs a public health approach that focuses on achieving population
outcomes. In instituting the SPF process, Oklahoma is transitioning from a focus on services to
individuals or small groups of consumers to population‐based approaches that view community well‐being
as the unit of outcome measurement, and from agency‐centered services to coordinated,
multisector systems approaches that use evidence‐based practices to achieve and change.
ODMHSAS and its state‐ and community‐level partners are committed to implementing the five steps of
the SPF process to enhance state and community prevention system accountability, capacity, and
effectiveness. This dynamic, systematic process to build infrastructure and capacity and achieve results
provides a logical framework that addresses five key steps:
1. Assessment of substance abuse and related problems, resources and gaps, contextual conditions,
and readiness to act through data collection and analysis
2. Mobilization of stakeholders and
financial/organizational capacity
building at state and community
levels to address the priority issues
identified in the assessment process
3. Development of a comprehensive
strategic plan that aligns resources
with locally, culturally, and
Okla homa Department of Mental Health and Substance Abuse Services Page 8
developmentally appropriate strategies that have been documented to be effective in addressing
the state’s/community’s identified priority issues
4. Implementation of state/local strategic plan that identifies timelines, processes, activities, and
responsibilities
5. Ongoing evaluation and monitoring of progress toward achieving outcomes, making adjustments as
needed to ensure continuous improvement.
The SPF is an iterative process in which each step tests the validity of conclusions drawn in previous
steps—sometimes requiring revisions to earlier assumptions. Oklahoma will continually assess new
information. Initially the focus will be on substance abuse‐specific data relative to the SPF SIG priorities,
but over time the state plans to expand its assessment to include related prevention areas such as child
abuse, domestic violence, and suicide. Based on data analysis findings, the state will mobilize new
stakeholders and partners, as appropriate; continue to build capacity to deal with broader and more
complex issues; plan and implement new or expanded initiatives; and evaluate progress in building
system capacity and achieving identified outcomes at the state and local levels.
The SPF includes interwoven emphases on cultural competence and sustainable systems and outcomes.
It is essential to recognize that every Oklahoma community is composed of subgroups with unique
and complex cultural needs, and to include these diverse populations in every facet of prevention
planning. Oklahoma also will work to develop the organizational capacity and stakeholder
commitment needed to create an adaptive and effective prevention system that can achieve and
maintain the desired long‐term results, resulting in a dynamic and sustainable prevention system.
Because the Oklahoma Department of Mental Health and Substance Abuse Services is responsible for
providing services to Oklahomans who are affected by mental illness as well as substance abuse, the
infrastructure built by the Department using its SPF SIG funding will provide a foundation for the
prevention of the myriad mental, emotional, and behavioral disorders, many of which share the same
risk and causal factors and could benefit from shared interventions using proven, evidence‐based
practices and expanded community‐based services.
The Oklahoma Strategic Plan for the Prevention of Mental, Emotional, and Behavioral Disorders supports
Oklahoma’s broadened focus on multisector prevention systems development, affording the state
expanded opportunities for multiagency cooperative interventions using shared strategies to serve the
same or similar populations or to target mutual outcomes, and encourages the application of systems
theory and knowledge to design and evaluate comprehensive prevention initiatives.
Okla homa Department of Mental Health and Substance Abuse Services Page 9
II. Assessment
Assessing the Problem
Epidemiology, the science of public health, provides vital information about disorders that threaten the
health and well‐being of populations. Epidemiological data identify problems, help determine what
areas and who are affected by the problems—knowledge that is essential for effective intervention—
and measure the success of interventions aimed at preventing or reducing these problems. Engagement
in a thoughtful planning process that includes careful assessments of needs, resources, capacity,
readiness, and contextual conditions—prior to selecting strategies—is essential to successful prevention
efforts.
This data focus—collection, analysis, and use—is entrenched in each step of the SPF and continually
informs the process. The formal assessment of contextual conditions, needs, resources, readiness, and
capacity is used to identify priority issues in Step 1. In Step 2, data are shared to generate awareness,
spur mobilization, and leverage resources. In Step 3, assessment data are used to drive the development
of a strategic plan and guide the selection of evidence‐based strategies. Data are used in Step 4 to
inform (and, if necessary, revise) the implementation plan. And finally, data are collected to monitor
progress toward outcomes, and findings are used to make adjustments and develop sustainable
prevention efforts.
The Oklahoma State Epidemiological Outcomes Workgroup (SEOW) is a multidisciplinary workgroup
whose members are connected to key decision‐making and resource allocation bodies in the state. This
workgroup, funded through a Federal grant from SAMHSA/CSAP, was established by ODMHSAS in 2006
and is patterned after the National Institute on Drug Abuse (NIDA) community epidemiological
workgroup. Oklahoma’s SEOW is charged with improving prevention assessment, planning,
implementation, and monitoring efforts through data collection and analysis that accurately assesses
the causes and consequences of the use of alcohol, tobacco, and other drugs and drives decisions
concerning the effective and efficient use of prevention resources throughout the state.
To study the nature and extent of the problem of alcohol, tobacco, and other drug use in Oklahoma, the
state’s SEOW utilized the CSAP model of consumption and consequence constructs and indicators. Table
1 provides a complete listing of alcohol, tobacco, and illicit and prescription drug consumption and
consequence constructs. For each construct, one or more identifiable indicators (measures) were used
to quantify consumption and substance‐related consequences. Unlike the underlying constructs, these
indicators are precisely defined and determined by specific data sources. Thus, while “alcohol‐related
mortality” is a relevant construct for monitoring trends of an important consequence of use, it does not
provide a precise definition of how this construct can be measured. However, a number of indicators do
provide specific measures of this construct (e.g., annual incidence rate of deaths attributable to alcohol‐related
chronic liver disease, suicide, homicide, or crash fatalities). A list of constructs and indicators for
alcohol and illicit drug consumption and consequences appear in the epidemiological data tables on
pages 54–59.
Okla homa Department of Mental Health and Substance Abuse Services Page 10
CSAP recommendations were not available for prescription drugs, so Oklahoma used the same data
sources CSAP recommended for the other constructs and indicators.
Table 1. Alcohol, Tobacco, Illicit Drugs, and Prescription Drug Consumption and Consequence Constructs
Alcohol Tobacco Illicit Drugs Prescription Drugs
Consumption • Current use •Current use • Current use
• Age of initial use •Lifetime use
•Age of initial use
• Drinking and driving
Consequence •Alcohol‐related mortality
• Alcohol‐related Crime
•Dependence or abuse
•Total cigarette use
consumption per
capita
• Apparent per capita alcohol
• Alcohol‐related motor vehicle
crashes
•Tobacco‐related
mortality
•Illicit drug‐related
mortality
•Illicit drug‐related
crime
•Dependence or
abuse
•Prescription opiate‐related
mortality
• Current use
• Heavy drinking
• Age of initial use
• Current binge drinking
• Alcohol use during pregnancy
•Tobacco use during
pregnancy
The SEOW required data indicators for each substance to be readily available and accessible, with the
measure available in disaggregated form at the State or lower geographic level. The method or means of
collecting and organizing the data also had to be consistent over time; if for any reason the method of
measurement had changed, reliable data had to be available to allow adjustment for differences
resulting from data collection changes. In addition, research‐based evidence had to support that the
indicator accurately measured the specific construct and yielded a true representation of the
phenomenon at the time of assessment, with data collected—preferably on an annual, or at minimum, a
biennial basis—for the preceding 3 to 5 years. And each indicator had to be sufficiently sensitive to
detect change over time that might be associated with changes in alcohol, tobacco, or illicit drug use.
Alcohol Consumption
According to Oklahoma’s Youth Risk Behavior Survey (YRBS), in 2009, 39.0 percent of students in grades
9–12 reported current alcohol consumption. That percentage is consistent with data collected by the
National Survey on Drug Use and Health (NSDUH) for the population aged 12 and older, which showed
42.5 percent of respondents were current drinkers in 2007. YRBS data also showed 28 percent of
adolescents were binge drinkers at the time of the survey. Although youth binge drinking is on the
decline, with the exception of 2009, Oklahoma has been consistently above the national average for this
behavior according to the YRBS. NSDUH data from 2007 indicated 37.4 percent of 18‐ to 25‐year‐olds
and 9.0 percent of 12‐ to 17‐year‐olds were binge drinkers. The 2009 YRBS showed 19.4 percent of
Oklahoma students in grades 9–12 reported early initiation of alcohol; a continued indication of a steady
decline in that behavior since the 2003 YRBS report of 26.8 percent.
While adolescent drinking and driving is trending downward, Oklahoma continues to have percentages
higher than the national average. In 2003, Oklahoma’s percentage of adolescent drunk driving was 17.5
percent, which was 45 percent higher than the national average. This dropped to 11.0 percent in 2009,
which was 13 percent higher than the national average of 9.7 percent.[1]
Okla homa Department of Mental Health and Substance Abuse Services Page 11
Figure 1.YRBS 2003–2007 Percentage of Students in Grades 9–12 Who Reported
Driving When They Had Been Drinking
Indicators from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) show Oklahoma is lower
than the national average in current alcohol consumption, heavy consumption, and binge drinking
among adults. In 2009, 42.6 percent of Oklahoma adults reported current alcohol consumption, which
was 27 percent lower than the national average of 54.3 percent.[2]
Although lower than the national average, NSDUH data indicates Oklahoma’s percentage of binge
drinking among persons 12 and older has increased from 2003‐2007. The percentage was 19.01 in 2003
and 21.2 in 2007.[3]
Figure 2. BRFSS 2009 Alcohol Consumption Categories
Data from the Pregnancy Risk Assessment Monitoring Survey (PRAMS) show that alcohol use among
pregnant women has been climbing in Oklahoma since 2003, when 2.5 percent of pregnant women had
consumed alcohol during the last 3 months of their pregnancy. In 2007, the percentage had increased to
4.8 percent of pregnant women.[4]
Alcohol Consequences
Oklahoma is consistently above the national average in alcohol‐related mortality. Long‐term alcohol
consumption is associated with chronic liver disease. The relationship between alcohol use and suicide is
also well documented, according to CSAP. Both chronic liver deaths and suicide deaths have been on the
rise in Oklahoma since 2003.[5,6,7]
17.5
12.3 13.3
11.00
12.1
9.9 10.5 9.7
0
5
10
15
20
2003 2005 2007 2009
Oklahoma
Nation
42.6
12.9
3.4
54.3
15.7
5.1
0
10
20
30
40
50
60
Current
Drinker
Binge Drinker Heavy Drinker
Oklahoma
Nation
Okla homa Department of Mental Health and Substance Abuse Services Page 12
Figure 3. 2003–2006 National Vital Statistics System (NVSS)
Oklahoma Chronic Liver Disease and Suicide Mortality
Data Deaths per 100,000
According to the Uniform Crime Reports (UCR), Oklahoma has also been consistently above the national
average in crimes related to alcohol use which include aggravated assaults, sexual assaults, and
robberies. Since 2003, there has been an 18.1 percent increase.[8]
Figure 4. 2005–2008 UCR Number of Violent Crimes Reported to Police Per 100,000
Population
Fatality Analysis Reporting System (FARS) data show that Oklahoma has maintained a steady rate of
fatal crashes involving an alcohol‐impaired driver. In 2003, Oklahoma’s alcohol‐impaired driver fatality
rate was 31.3 percent, and in 2008, that figure remained relatively stable at 31.6 percent. National
percentages for those years were 30.3 and 31.4, respectively.[9]
Tobacco Consumption
According to the 2007 NSDUH, 30.6 percent of Oklahomans aged 12 and older were current cigarette
smokers, which was above the national average of 24.2 percent. Data from the 2009 BRFSS also showed
Oklahomans’ daily cigarette smoking exceeding that of the United States population as a whole, at 25.4
percent vs. 17.9 percent, respectively.[2,3]
The YRBS shows indicators in tobacco use among adolescents have been falling in Oklahoma since 2003,
with students who smoked their first cigarette before the age of 13 decreasing by half since that year.[1]
9.413.6 10.314.4 11.314.7 12.415.0
0
5
10
15
20
2003 2004 2005 2006
Chronic Liver
Disease
Suicide
508.6
497.4 499.6
526.7
469.0 473.6 466.9
454.5
400.0
420.0
440.0
460.0
480.0
500.0
520.0
540.0
2005 2006 2007 2008
Oklahoma
Nation
Okla homa Department of Mental Health and Substance Abuse Services Page 13
Figure 5. YRBS 2003–2009 Percentage of Students in Grades 9–12
Who Reported Smoking a Whole Cigarette for the First
Time Before the Age of 13.
Smoking among pregnant women is climbing in Oklahoma according to PRAMS. In 2003, 16.2 percent of
pregnant women reported they had smoked during the last 3 months of their pregnancy; in 2007, the
most recent PRAMS for which data are currently available, the percentage of pregnant women who
smoked during the last 3 months of pregnancy had jumped to 21.3.[4]
Tobacco Consequences
National Vital Statistics System (NVSS) data show deaths from both chronic obstructive pulmonary
disease (COPD) and emphysema for Oklahoma are above the national average.[10]
Figure 6. NVSS 2006 COPD/Emphysema and Lung Cancer Deaths Per 100,000
Illicit Drug Consumption
The YRBS shows daily marijuana use for high school students in grades 9–12 is decreasing; 22.0 percent
were daily users in 2003, while just 15.9 percent reported this behavior in 2007.[1]
According to NSDUH, Oklahoma has been consistently above the national average among persons aged
12 and older reporting the use of any illicit drug other than marijuana. The percentages were 4.1 in 2004
and 4.6 in 2007. The national percentages for those same years were 3.4 and 3.7, respectively.[3]
23.7
20.2
15.6
11.5
0
5
10
15
20
25
2003 2005 2007 2009
Oklahoma
60.0
68.2
40.5
53.1
0.0
20.0
40.0
60.0
80.0
COPD/Emphysema Lung Cancer
Cause of Death
Oklahoma
Nation
Okla homa Department of Mental Health and Substance Abuse Services Page 14
Although still above the national average, youth methamphetamine use continues to decline in
Oklahoma according to the YRBS. Since 2003, the percentage of youth methamphetamine users has
dropped by half.[1]
Figure 7. YRBS 2003‐2009 Percentage of Oklahoma Students in Grades 9–
12 Who Reported Ever Using Methamphetamines
The YRBS also shows Oklahoma exceeds the national average in cocaine, ecstasy, steroid, and inhalant
use. Although above the national average, cocaine use in Oklahoma has dropped from 9.2 percent in
2003 to 7.4 percent in 2009.[1]
Although initially below the national average in years 2003–2007, adolescent use of inhalants is on a
steady ascent. In 2009, 12.7 percent of Oklahoma adolescents reported inhalant use, surpassing the
national average of 11.7 percent.[1]
Figure 8. 2003‐2009 YRBS Percent of Students in Grades 9–12 Who Reported
Ever Using Any Form of Inhalant
Illicit Drug Consequences
The latest NVSS data show that Oklahoma exceeds the Nation in number of deaths due to drug‐related
behavior. In 2006, the rate per 100,000 was 17.3 for Oklahoma and 12.8 for the United States as a
whole.[5]
9.9
7.1
5.5
4.8
0
2
4
6
8
10
12
2003 2005 2007 2009
9.9
12.0 11.7
12.1 12.4 12.7
13.3
11.7
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
2003 2005 2007 2009
Oklahoma
Nation
Okla homa Department of Mental Health and Substance Abuse Services Page 15
The number of drug‐related crimes (larceny, burglary, motor vehicle theft) in Oklahoma also outstrips
that of the Nation; in 2008, Oklahoma reported 3,442.4 per 100,000 compared to the national rate of
3,212.5 per 100,000. However, Oklahoma’s 2008 rate does represent a decline for the state, which
reported drug‐related crimes of 4042.0 per 100,000 in 2005.[8]
Prescription Drug Consumption
According to data from the 2007 NSDUH, Oklahomans aged 12 and older exceeded the national average
for the consumption of painkillers for nonmedical use by 232 percent. This is a 22 percent increase since
2004.[3]
Prescription Drug Consequences
Although hospital inpatient discharge data were not indicators used in scoring, they were presented to
the State Epidemiological Outcomes Workgroup (SEOW) due to the paucity of indicators regarding
prescription drugs. Oklahoma hospital data associated with opiates have shown a 91 percent increase
since 2003. Although this is a general category for opiates, for all practical purposes, heroin is the only
illicit opiate taken into account.[11]
NVSS data show there has been a 328 percent increase in opiate‐related deaths in Oklahoma since 1999.
In 2006, Oklahoma ranked 4th in the Nation for opiate overdose deaths, exceeding the national average
by 123 percent.[12]
Figure 9. NVSS 1999‐2006 Opioid Overdose Deaths Per 100,000 Population
Mental and Emotional Disorders
The Oklahoma SEOW intends to expand its scope to collect and analyze epidemiological data on the
nature and extent of mental illness and related indicators in the state. The broadening of the SEOW’s
scope of work is critical for Oklahoma to gain more understanding about opportunities for mental illness
prevention and mental health promotion within the state. In addition, developing research supports the
connection between mental and emotional disorders, their causal factors, and other behavioral health
problems, including substance abuse. Therefore, it is imperative that Oklahoma apply the same
0
2
4
6
8
10
12
1999 2000 2001 2002 2003 2004 2005 2006
Rate
Oklahoma
US
.
Okla homa Department of Mental Health and Substance Abuse Services Page 16
assessment standards integral to the SPF process for the prevention of mental and emotional disorders
as has been done for substance abuse.
Mental disorders (brain dysfunction disorders) account for 25 percent of disability in the United States.
About 22 percent of the U.S. adult population has one or more diagnosable disorders in a given year.
Oklahoma currently ranks number one in the Nation for the prevalence of these disorders in adults.[13]
Mental illness can influence the onset, progression, and outcome of other illnesses. Anxiety, impulse
control, and mood disorders often correlate with health risk behaviors such as substance abuse, tobacco
use, and physical injury. Depression is a risk factor for such chronic illnesses as hypertension,
cardiovascular disease, and diabetes. Mental illness and depression also increase the risk for suicide.
Oklahoma has consistently had a higher number of suicide deaths compared to the rest of the Nation. In
Oklahoma, suicide is the most common manner of violent death. The first quarter of 2010 has yielded a
sharp increase in calls to Oklahoma’s suicide prevention hotline. In 2009, for example, there were 833
calls during the first quarter. In the first quarter of 2010 there has been a 53.0 percent increase, with
1,272 clients having called the hotline.[14]
From 2004–2007, the rate of suicide was 14.4 per 100,000 according to the Oklahoma Violent Death
Reporting System (OVDRS). Data from OVDRS also show that suicide was the third‐leading cause of
death among 15‐ to 24‐year‐olds in 2007. The suicide rate reported by Oklahoma for this population was
13.5 percent higher than the national rate among the corresponding age group. And in fact, among all
ages, Oklahoma’s reported suicide rate is higher than the national average. In 2006, Oklahoma’s rate per
100,000 was 15.0, compared to the national average of 10.9. Seventy‐eight percent of suicides were
males. Depression was the leading circumstance associated with suicide. Forty‐six percent of suicides
were the result of a depressed mood. Substance use also played a role in suicides according to OVDRS.
Thirty percent of persons tested had a positive blood alcohol test, and 88 percent tested positive for
other drugs.[15]
In 2007, NSDUH reported that 14.0 percent of Oklahomans aged 18 and older suffered from serious
psychological distress. Table 2 shows several mental health indicators for which Oklahoma had some of
the highest percentages in the Nation in 2006–2007. In addition, results from the 2009 BRFSS show 20.7
percent of Oklahoma adults had between 1 and 13 mentally unhealthy days in the last month, and 13.7
percent had between 14 and 30 such days.[3]
Table 2. NSDUH, 2006–2007 Annual Averages
Mental Health Indicator Percent
Serious psychological distress in the past year (age 18 and older) 14.0
Serious psychological distress in the past year (age 26 and older) 13.2
Persons having at least one major depressive episode in the past year (age 18 and older) 9.1
Persons having at least one major depressive episode in the past year (age 18–25) 10.5
Persons having at least one major depressive episode in the past year (age 26 and older) 8.9
Okla homa Department of Mental Health and Substance Abuse Services Page 17
ODMHSAS reported 34,132 persons received ODMHSAS‐funded mental health services for fiscal year
2004. In 2009, that number increased to 52,226. In 2009, the top three reasons clients sought services
were emotional maladjustment/disturbance (38.9 percent), substance abuse disorders (29.0 percent),
and depressive disorders (7.0 percent). The top drug of choice was alcohol. The age groups of clients
that had the highest percentages of service were 25–34 (23.5 percent) and 35–44 (21.0 percent). The
gender breakdown of clientele was virtually the same. Of the clients who were given a substance abuse
screening, 57.0 percent tested positive.[16]
The number of children with serious emotional disturbance (SED) receiving ODMHSAS‐funded mental
health services increased 76 percent over a 5‐year period, from 2,254 in 2004 to 3,959 in 2009. Persons
with serious mental illness (SMI) receiving ODMHSAS‐funded mental health services increased from
25,492 in 2004 to 38,222 in 2009—an increase of approximately 50 percent.[16]
Data from the YRBS show that, in 2009, 28.2 percent of students felt sad or hopeless everyday day for 2
weeks or more in a row to the extent that they stopped doing some usual activities during the past 12
months; this was slightly higher than the national average of 26.1 percent.[1] Oklahoma Systems of Care,
a comprehensive spectrum of mental health and other support services for adolescents and their
families with a serious emotional disturbance, has experienced a 73 percent increase in enrolled clients
since fiscal year 2006—jumping from 456 in 2006 to 787 in 2010. The majority of clients are white, male,
and diagnosed with conduct disorders.[17]
Populations of Note
American Indian
In 2000, the American Indian and Alaska Native (AI/AN) population in Oklahoma was 266,801,
comprising 8 percent of the state’s total population and ranking Oklahoma second among all states for
AI/AN population. Alcohol and tobacco consumption is a significant problem in this population.
According to data from the 2009 BRFSS, 14.2 percent of AI/AN adults reported binge drinking, and 4.0
percent reported heavy drinking; both percentages exceed those reported by any other race. Smoking
consumption was also highest among this group according to the BRFSS. In 2009, 31.9 percent AI/ANs
reported current smoking compared to all other races (25.0 percent).
Data from the Oklahoma State Bureau of Investigation (OSBI) show Oklahoma’s AI/AN population had
substantially greater alcohol‐related arrests (i.e., driving under the influence, liquor law violations and
drunkenness) at 44 percent; lower drug law violation arrests (i.e., all drug arrests reported as
sale/manufacturing and possession) at 8 percent; and lower index crime arrests (i.e., murder, rape,
robbery, aggravated assault, burglary, larceny, and motor vehicle theft) at 10 percent, compared to all
races combined (29 percent, 14 percent, and 13 percent, respectively).
From fiscal years (FYs) 2001–2008, Oklahoma’s AI/AN population had consistently high rates of persons
served in substance abuse treatment facilities compared to Whites and people of all races combined.[18]
Older Adults
Older Oklahomans, aged 65 and above, are the fastest growing segment of the state’s population. In
2006, Oklahoma had the 19th‐highest number of persons aged 65 and over, with 475,637 individuals
Okla homa Department of Mental Health and Substance Abuse Services Page 18
falling into this category (U.S. Census Bureau, 2006). The population ages 60 and older increased by 18.2
percent from 1980 to 2000. This is substantially higher than the national average of 12.4 percent. In
2000, Oklahoma ranked 13th in terms of the percentage of the total population 60 years and older .This
high growth rate among senior citizens outpaced Oklahoma’s overall growth rate of 14 percent for the
same period. The very old (85 years and older) experienced the most notable growth rate of 61 percent
from 1980 to 2000. It is estimated that while Oklahoma’s total population will grow at a relatively slow
pace (10.2 percent), those 65 years and over will increase by over 60 percent between 2007 and 2030.
Further, the state’s population ages 85 years and older is expected to increase by 50 percent during the
same time period (U.S. Census Bureau, 2006).[13]
Figure 10.
According to Oklahoma’s 2009 BRFSS, 78.8 percent of persons aged 65–74 said that they always or
usually received social and emotional support. This was down from 2005, when the percent was 83.1.
Conversely, this among persons aged 75 and older, 77.6 percent always or usually received support in
2005 and 78.4 percent did in 2009.[3]
Another significant characteristic within the state’s older populations is grandparents raising
grandchildren. Approximately 43,000 older Oklahomans are responsible for their grandchildren; of
these, 16,200 have been responsible for the care of their grandchildren 5 years or longer. Grandparents
living with grandchildren under 18 years of age for the population 30 years and over households are
shown in the following table.[13]
0
10
20
30
40
50
60
70
80
1980-90 1980-2000
Percent growth 1980–1990, 1980–2000
Total OK pop
60 +
85 +
Okla homa Department of Mental Health and Substance Abuse Services Page 19
Household types United States Oklahoma
Total households 30+ years 158,881,037 1,915,455
Grandparents living with grandchildren under 18 5,771,671 67,194
Grandparents responsible for their grandchildren 2,426,730 39,279
Grandparents responsible for their grandchildren 5 years or more 933,408 14,714
Source: U.S. Census 2000
Veterans and Military Families
In Oklahoma, 12.5 percent (333,358) of the state’s citizens are veterans, with 20.7 percent having served
in the Gulf War, 35.1 percent having served in Vietnam Conflict, 12.7 percent having served in the
Korean War, and 13 percent having served in World War II. The American Forces News Services reports
that over 47,000 individuals based in Oklahoma are active in military operations and 24,500 have been
deployed since American troops entered Afghanistan (www.usmilitary.about.com. 2008). In addition to
other mental health disorders, 20 percent of returning veterans suffer posttraumatic stress disorder.[13]
According to the OVDRS, 23 percent of suicide deaths between 2004 and 2007 were veterans, which
represented 76 percent of all violent deaths among veterans.[15] In addition, a comparison of mortality
between Operation Enduring Freedom/Operation Iraqi Freedom Veterans and the general U.S.
population (adjusted for age, sex, race, and calendar year) showed evidence of a 21 percent excess of
suicides among veterans through 2007. Although the evidence is preliminary, it suggests decreased
suicide rates since 2006 among veterans of both sexes aged 18–29 who have used Veterans Health
Administration (VHA) health care services relative to veterans in the same age group who have not. This
decrease in rates translates to approximately 250 lives per year. Finally, more than 60 percent of
suicides among users of VHA services include patients with a known diagnosis of a mental health
condition.[19]
Incarcerated Women
According to the Oklahoma Department of Corrections (ODOC), Oklahoma leads the Nation in the rate
of female offender incarceration at 131 per 100,000 population, a significant departure from the
national average of 69 per 100,000 population. As of 2006, 2,213 women were incarcerated in the State
of Oklahoma, and the state’s female inmate population is growing more rapidly than its male inmate
population. Analogous to this rise in incarcerated females is a rise in incarcerated female drug use (i.e.,
both personal use and drug‐related crimes).
From 2001 to 2007, the number of female prison admissions per year increased by 136 (12 percent). Of
the total female prison admissions during this time, 5,308 (61 percent) were White; 2,141 (24 percent)
were Black; 998 (11 percent) were American Indian or Alaska Native; and 274 (3 percent) were Hispanic.
According to the Bureau of Justice Statistics (2002), 52 percent of the Nation’s female inmates were
dependent on drugs or alcohol. Of all the offenses listed for incarcerated women between 2001 and
2007 in Oklahoma, approximately 70 percent were associated with a controlled substance (i.e., a drug or
chemical substance whose possession and use are controlled by law), alcohol, or both.[18]
Okla homa Department of Mental Health and Substance Abuse Services Page 20
Assessing the Current Prevention System (Capacity and Infrastructure)
At the state level, prevention services are managed through ODMHSAS, which is the Single State
Authority (SSA) responsible for publicly funded substance abuse and mental illness prevention services.
The ODMHSAS Prevention Services Division is led by Commissioner Terri White, Deputy Commissioner
Steven Buck and Division Director Jessica Hawkins, with a management team and staff of 16 full‐time
equivalents funded through multiple state and Federal sources.
A number of different governing groups guide and inform the strategic direction of the state’s substance
abuse and mental health prevention service system:
• The Prevention Services Division is monitored and overseen by the agency’s Governing Board.
• The Oklahoma Prevention Leadership Collaborative (OPLC), developed in 2010, is expected to
serve as a guiding council on state prevention priorities and coordination among state agencies
related to prevention services.
• The ODMHSAS Prevention Services Division staffs three statewide committees charged with
setting priorities on significant state prevention initiatives, including the Governor’s Task Force
on the Prevention of Underage Drinking, the Oklahoma Suicide Prevention Council, and the
Oklahoma Crystal Darkness Collaborative (focusing on the prevention of methamphetamine
use).
• The SEOW was convened to collect and report on substance abuse consumption and
consequence data to help identify and monitor state priorities for ODMHSAS and other
agencies. The Oklahoma SEOW intends to expand its scope to analyze other behavioral and
physical health data as a service to other state agencies using a data‐driven prioritization
process.
• The Oklahoma Prevention Policy Alliance is a nonprofit advocacy organization comprised of
state‐ and local‐level prevention supporters who advance state and municipal prevention‐related
policy agendas.
• The Behavioral Health Development Team (BHDT) is a subcommittee of the State Advisory Team
for Oklahoma’s Systems of Care initiative. The membership of the BHDT includes a designee for
each member of the Partnership Board, which includes all eight child‐serving agencies
(ODMHSAS, Department of Human Services, Department of Rehabilitative Services, Office of
Juvenile Affairs, Oklahoma Commission on Children and Youth, State Department of Education,
Oklahoma Health Care Authority, and Oklahoma State Department of Health). The BHDT's
primary focus is on researching options for developing the needed infrastructure and services
for Systems of Care. The team develops recommendations for the Partnership for Children’s
Behavioral Health Board (PCBH), and creates specific implementation plans based on the
decisions and guidance of the PCBH Board. Recently, the BHDT has adopted a strategic plan that
includes behavioral prevention priorities, including community‐based prevention approaches
(through Oklahoma’s Area Prevention Resource Centers) and suicide prevention.
The Area Prevention Resource Centers (APRCs), which are funded by state‐appropriated funds and the
Federal Substance Abuse Prevention and Treatment (SAPT) Block Grant administered by SAMHSA, are
Okla homa Department of Mental Health and Substance Abuse Services Page 21
the backbone of Oklahoma’s prevention service system. There are 17 regional APRCs serving all 77
counties in Oklahoma. APRC Directors convene quarterly with ODMHSAS staff at the Oklahoma
Prevention Network meetings. APRC staff are certified prevention specialists and receive regular training
on evidence‐based prevention strategies and principles, including the SPF. APRCs develop, in
partnership with community coalitions, community‐level prevention workplans based on the SPF and
aligned with state prevention priorities. Services are focused on achieving sustainable, population‐level
outcomes. APRC staff are charged with implementing community‐level workplans in collaboration with
community coalitions and building local‐level prevention capacity. Services provided and guided by the
APRCs are evaluated at the local level. A contract with the University of Oklahoma’s College of Public
Health, to provide training and technical assistance on evaluation as well as overall Block Grant
evaluation services, is slated to commence in 2010.
The ODMHSAS Prevention Services Division administers 2much2lose (2m2l), which is the overarching
moniker of Oklahoma’s underage drinking prevention initiative funded by the Office of Juvenile Justice
and Delinquency Prevention’s Enforcing Underage Drinking Laws Block Grant program. 2m2l represents
an array of efforts, including a youth leadership development program and underage drinking law
enforcement activities. Regional 2m2l Coordinators provide training and technical assistance to local
2m2l youth chapters and law enforcement throughout the state on best practice strategies for underage
drinking prevention. There is a 10‐member state 2m2l Youth Council that advises ODMHSAS on local and
state youth training, as well as two regional cross‐jurisdictional law enforcement task forces that
implement high visibility underage drinking operations throughout the year.
The ODMHSAS Prevention Services Division also manages a number of other Federal and state
substance abuse prevention grant programs, including the Oklahoma Partnership Initiative funded by
the Administration on Children and Families to provide prevention services to children in substance
abusing families; the Oklahoma Methamphetamine Prevention Initiative funded by SAMHSA/CSAP to
implement evidence‐based meth prevention interventions in high‐risk communities; a responsible
beverage sales and service training program and underage/high‐risk drinking law enforcement effort
funded by a Justice Assistance Grant from the Oklahoma District Attorneys Council; and administration
of a program to prevent youth tobacco retail sales to minors funded by the Oklahoma Tobacco
Settlement Endowment Trust. Finally, ODMHSAS Prevention Services Division has a professional on staff
to develop a statewide infrastructure for Screening, Brief Intervention, and Referral to Treatment
(SBIRT) services and advise on advances in state and Federal health reform as it relates to the
prevention of mental, emotional, and behavioral disorders.
In addition to substance abuse prevention, ODMHSAS Prevention Services Division operates two mental
health promotion initiatives. The Oklahoma Youth Suicide Prevention Initiative is funded by the SAMHSA
Center for Mental Health to implement state and local strategies such as training, screening, and
community capacity building to prevent suicide and develop prepared communities. Second, the Mental
Health First Aid training program supports a network of trainers throughout the state to increase
community knowledge of mental illness, identify warning signs, and administer effective help when
signs are recognized.
Okla homa Department of Mental Health and Substance Abuse Services Page 22
Oklahoma continues to work toward a collaborative substance abuse prevention system that ensures
the use of evidence‐based programs and policies and demonstrates accountability among partners. The
ODMHSAS Prevention Services Division partners with a number of other agencies to coordinate and
implement prevention services. These agencies include, but are not limited to, those shown in the
following table.
Agency Target Population
Cherokee Nation Behavioral Health Services Cherokee Nation
Oklahoma State Department of Education Youth
Oklahoma State Department of Health All Citizens
Oklahoma Department of Public Safety/Highway Safety Office All Citizens
Office of Faith‐based Initiatives All Citizens
Office of Juvenile Affairs Youth
Oklahoma Bureau of Narcotics and Dangerous Drugs All Citizens
Oklahoma Commission on Children and Youth Youth
Oklahoma Health Care Authority All Citizens
Oklahoma Institute for Child Advocacy Youth
Oklahoma National Guard Youth/Military Families
Oklahoma State Regents for Higher Education College
Oklahoma State Parent‐Teacher Association Families
Criteria and Rationale for SPF SIG Priorities
In July 2009, Oklahoma received a 5‐year Strategic Prevention Framework State Incentive Grant from
SAMHSA/CSAP. The ODMHSAS Prevention Services Division administers the Oklahoma SPF SIG project.
The purpose of the SPF SIG funding is for states to build the infrastructure necessary to prevent the
onset and reduce the progression of substance abuse and related problems, as well as build prevention
capacity and infrastructure at the state and community levels. The following describes the processes by
which the state determined substance abuse‐specific priorities for the 5‐year SPF SIG initiative. The
same process will be applied utilizing the infrastructure developed via the SPF SIG to determine
prevention priorities related to mental and emotional disorders.
On March 26, 2010, Oklahoma held its SPF SIG kickoff meeting in Oklahoma City, with members of CSAP
present. At that meeting, the SEOW discussed the existence and purpose of the Oklahoma Tobacco
Settlement Endowment Trust. Oklahoma is the only state in the Nation that has constitutionally
protected the majority of its Master Settlement Agreement (MSA) funds in an endowment to ensure a
growing funding source. Earnings have increased each year from a low of $650K in FY 2002 to a high of
$18M in FY 2010. Given this large, dedicated funding stream, which ensures that funds will be available
for tobacco prevention for many generations to come, the State Tobacco Control Program endorsed the
omission of tobacco issues from consideration by the SEOW in favor of Oklahoma using its SPF SIG
funding to support other substance‐related issues currently receiving less financial support in the state.
Okla homa Department of Mental Health and Substance Abuse Services Page 23
The SEOW was tasked with analyzing the state epidemiological data to determine problem or emerging
alcohol and other drug consumption and consequence patterns. The SEOW decided to categorize
indicators into one of three substance categories: alcohol, illicit drugs, and prescription drugs.
CSAP provides an excellent list of indicators, solid reasoning for selecting these indicators, and equally
sound explanations for the exclusion of certain indicators. On its Web site,
https://www.epidcc.samhsa.gov/background/criteria.asp, CSAP fully details why each indicator was
selected or rejected. It was CSAP’s sound logic that convinced the SEOW to use its recommendation of
indicators for evaluating each substance.
1) National source. The measure must be available from a centralized, national data source.
2) Availability at state level. The measure must be available in disaggregated form at the state (or
lower geographic) level.
3) Validity. There must be research‐based evidence that the data accurately measure the specific
construct and yield a true snapshot of the phenomenon at the time of assessment. These
criteria are used to eliminate measures that look at face value as if they assess a particular
construct, but are in fact poor or unproven proxy measures and thus do not accurately reflect
the construct. Because OPNA is conducted using a convenience sample, the SEOW voted not to
include these data in the process since such data would not be a valid measure of consumption
and consequence at the state level.
4) Trend. The measure should be available for the past 3 to 5 years, preferably on an annual basis,
but no less than a biennial basis. This enables the state to determine not only the level of an
indicator but also its trends.
5) Consistency. The measure must be consistent (i.e., the method or means of collecting and
organizing data should be relatively unchanged over time, such that the method of
measurement is the same from time i to time i+1). Alternatively, if the method of measurement
has changed, sound studies or data should exist that determine and allow adjustment for
differences resulting from data collection changes.
6) Sensitivity. For monitoring, the measure must be sufficiently sensitive to detect change over
time.
To prioritize each of the three substance categories for the State of Oklahoma, a set of consumption and
consequence indicators for each substance type was identified (see pages 54–60), and an index score
was computed for each substance based on the indicator data available to allow prioritization of each
substance category as follows:
1. A ratio comparing Oklahoma to the United States was calculated based on either the percentage
of use or rate of incidence for each year of available data for each consumption and
consequence indicator.
2. The ratios were summed for all of the consumption indicators and divided by the number of
data points to calculate an average of the consumption ratios.
Okla homa Department of Mental Health and Substance Abuse Services Page 24
3. A ratio average was calculated across the consequence indicators for the substance category.
The consequence ratio average was then multiplied by 2 due to CSAP’s history of placing an
emphasis on consequence data.
4. The ratio averages for consequence data and consumption data for each substance were added
together for the ratio score for each substance.
Next, time trends were analyzed to create a trend index for each substance category, increasing the
sensitivity of substance index scores to current trends. Because a general trend could have overlapping
confidence intervals—which may or may not represent a statistically significant trend—Oklahoma felt
the best way to control for this across all data sources was to conduct a regression analysis for each
indicator rather than look for a general trend. If a statistically significant increase was found, the
indicator was assigned a +1, if a statistically significant decrease was noted, the indicator received a ‐1.
If a significant trend was not found, then the indicator scored a 0. The scores for each substance were
then divided by the total number of indicators, and consequence data were multiplied by 2 and added
to the consumption score to create a trend index score for each substance.
To calculate the total index score for each substance category, the time‐trend data and the ratio data
were added together.
An example of the calculation of the substance category scoring method can be found on pages 61–62
of the appendix.
Substance Consumption = Oklahoma Indicator
National Indicator
Substance Consequence = Oklahoma Indicator
National Indicator ⁼ b
a+b
data points of substance
Substance Consumption = Linear Regression of Time Trend of Indicator
Substance Consequence= Linear Regression of Time Trend of Indicator
x+y (2)
data points of substance
Substance Score = c+z
⁼a
Ratio (*2)
⁼ x ( which is +1
increase, 0 no
change, ‐1 decrease)
⁼c
⁼z
⁼ y (which is +1
increase, 0 no
change, ‐1 decrease)
Following are the results of this process:
• Prescription drugs (9.44)
Okla homa Department of Mental Health and Substance Abuse Services Page 25
• Alcohol (3.54)
• Illicit drugs (2.75).
On May 26, 2010, the SEOW discussed the two priorities that had scored the highest in the process—
prescription drug misuse and alcohol use. The SEOW coordinator had reexamined the indicators
comprising each score. Although consequence data were not found to be age related (e.g., no matter
the age of the individual, drinking increased the likelihood of involvement in violent crime), findings
from this examination for the alcohol score clearly illustrated that the consumption indicators that were
above the national average were all youth related:
• Percent of students in grades 9–12 reporting any use of alcohol in the past 30 days
• Percent of students in grades 9‐12 reporting having five or more drinks on at least one occasion
in the past 30 days
• Percent of students in grades 9–12 who reported riding in a car driven by someone who had
been drinking
• Percent of students in grades 9–12 who reported driving when they had been drinking.
As a result, the SEOW elected to focus on underage rather than adult drinking. The nonmedical use of
prescription drugs—which scored nearly threefold higher than alcohol—also was chosen by the SEOW
as a priority issue that should be addressed by Oklahoma through its SPF SIG.
On June 22, 2010, the SEOW coordinator briefly discussed the state’s epidemiological data and the data
prioritization process at a meeting of the OPLC. The OPLC, which acts as the state’s SPF SIG Advisory
Committee, is the state‐level Collaborative established to promote the coordinated planning,
implementation, and evaluation of quality prevention services for children, youth, and families at the
state and local levels, with a particular focus on the prevention of mental, emotional, and behavioral
health disorders, related problems (e.g., alcohol and other drug use), and contributing risk factors.
The OPLC’s membership, as directed by the Oklahoma Secretary of Health and Commissioner of Mental
Health and Substance Abuse Services, includes not only the representation CSAP requires of the SPF SIG
advisory council, but a range of prevention representatives from across sectors (e.g., injury prevention,
child abuse prevention), as well as membership from the state PTA and tribal governments—specifically
those concerned with behavioral health. The group represents a broad array of connected issues. Since
the different problem areas (e.g., substance abuse, suicide, child abuse, etc.) share risk factors,
collaboration between OPLC members offers significant potential for shared interventions. It is the
OPLC’s responsibility to determine whether there is an investment Oklahoma can make as a state to
achieve population outcomes.
The responsibilities of the Council include, but are not limited to: identifying opportunities for
coordination and collaboration on prevention initiatives serving the same populations, using common
strategies, or aiming to achieve similar goals or outcomes; promoting the implementation of best
practices for prevention at the state and local levels; and serving, as requested, in an advisory role on
required state and Federal grant programs. Currently, the OPLC is focused on the SPF SIG funded by
Okla homa Department of Mental Health and Substance Abuse Services Page 26
SAMHSA and administered by ODMHSAS. Collaborative members will advise on important decisions
related to this cooperative agreement throughout the duration of the project.
Therefore, on July 13, 2010, a subgroup of the SEOW presented the workgroup’s findings and
recommendations to the OPLC. The SPF SIG project director, the SEOW coordinator, and the SPF SIG
evaluator provided an overview of the entire SEOW prioritization process; Donald Baker, Ph.D., of the
University of Oklahoma Anne and Henry Zarrow School of Social Work, presented the SEOW’s findings
on underage drinking; and Scott Schaeffer, R.Ph., of DABAT Oklahoma Poison Control Center, presented
the SEOW’s findings on nonmedical prescription drug use.
Description of SPF SIG Priorities
Based on the findings presented by the SEOW, the Collaborative endorsed that body's
recommendations and selected two SPF SIG priorities: underage drinking and prescription drug abuse.
Communities may choose one or both of the two priorities based on their own local‐level needs
assessment performed during the first six months of funding using the same process by the SEOW.
Underage Drinking
Oklahoma is consistently above the national average in alcohol‐related mortality and crime. In 2009,
39.0 percent of students in grades 9–12 reported current alcohol consumption. That percentage is
consistent with NSDUH’s data for individuals 12 years and older who reported being a current drinker,
which was 42.5 percent in 2007. Oklahoma’s adolescent binge drinking also consistently exceeds the
national average, with 2009 being the exception according to the YRBS. The SEOW was presented with
additional information when examining the persistence of the problem with underage drinking. The
YRBS showed that current alcohol use among 12th‐grade students was over 45 percent for 2009.
Although there has been a decline, nearly half of high school seniors are current drinkers, and over one‐fourth
of seniors reported binge drinking. In 2009, one quarter of 9th graders reported initiating alcohol
use before age 13. Over one in five high school seniors had ridden in a car with someone who had been
drinking, and 18.7 percent drove while drinking. Below are a sampling of possible indicators
communities may choose using the same process that the SEOW undertook, based on their needs
assessment findings:
• Past 30‐day alcohol use
• Binge drinking in the past 30 days
• Age of first use of alcohol
• Riding in a car driven by someone who has been drinking
• Driving after drinking.
Prescription Drug Abuse
In 2006, NVSS data ranked Oklahoma 4th in the Nation for fatal opioid poisonings, and in 2007, NSDUH
data showed Oklahoma was 232 percent above the national average in consumption of painkillers for
nonmedical use—a 22‐percent increase since 2004. Oklahoma has experienced a 328‐percent increase
in opiate deaths since 1999. In 2006, Oklahoma’s opiate‐related death rate was 123 percent higher than
Okla homa Department of Mental Health and Substance Abuse Services Page 27
the national average. Hospital data associated with opiates has shown a 91‐percent increase since 2003
in opiate admissions.
Below is a partial list of possible indicators for prescription drug abuse communities may choose using
the same process that the SEOW undertook, based on their needs assessment findings:
• Nonmedical use of prescription pain relievers in the past month
• Opioid overdose deaths
• Emergency room prescription drug abuse visits
• Hospital admissions for prescription drug abuse.
Okla homa Department of Mental Health and Substance Abuse Services Page 28
III. Capacity Building
Areas Needing Strengthening
While Oklahoma currently has an effective prevention system, there are areas that need strengthening.
Primarily, the prevention system will benefit from gaining the ability to: 1) build and sustain coalitions,
2) enhance understanding of how to identify or adapt strategies for specific cultures, 3) increase the
implementation of environmental strategies, and 4) build and sustain an evaluation system.
To identify areas for infrastructure improvement at both the state and community levels, ODMHSAS
conducted an infrastructure needs assessment in July 2010. State and local agency leads, ODMHSAS
staff, and community coalition members participated. Findings identified:
• Gaps in state and local partnerships,
• Workforce development needs, and
• The need for a comprehensive data warehouse with query capabilities.
Gaps in state and local partnerships included law enforcement, school boards, local education staff,
universities, businesses, media, alcohol industry, health care providers, parents, and child care
providers.
Workforce development needs included skills for coalition development and operations, engaging the
community and reaching all sectors, strategic planning, using data for decision‐making, evidence‐based
and environmental strategies, and sustainability planning.
State‐ and Community‐Level Activities
Diverse capacity building activities are being considered and planned for both the state and local
communities.
At the state level, Oklahoma government currently does not have a central location through which grant
opportunities are filtered (e.g., suggesting which agencies should apply for specific funding
opportunities as they become available). The OPLC provides a potential venue for bringing together a
broad group of prevention stakeholders to talk about how to blend funding, coordinate prevention
services, discuss state priorities—where only agency priorities previously existed—without taking away
from individual agency priorities, and come up with what the state can do to make a difference.
ODMHSAS staff or consultants trained in the SPF will be available to support the work and build the
capacity of other state systems. Providing agencies this assistance through shared training opportunities
and in‐kind embedded SPF consultants could increase their buy‐in to the process, making them more
likely to infuse the SPF into their own work. If successful, this will create a common approach and
language across systems.
In addition, other agencies are encouraged to use the SEOW as a tool to identify emerging issues and
areas of need, including treatment. ODMHSAS has a strong connection with other workgroups that
Okla homa Department of Mental Health and Substance Abuse Services Page 29
address suicide, tobacco, injury, maternal and child health, violence, and chronic disease; however,
these groups are not regularly assessing need in common or coordinated ways at this time. By formally
connecting these groups and allowing the SEOW to look at other areas (outside of substance abuse), the
state will be helping the SEOW to build its capacity while also identifying meaningful opportunities for
cross‐sector coordination.
SPF SIG technical assistance and training will be provided to the APRCs by two state prevention field
representatives, who also are responsible for monitoring the APRC contracts. These staff are trained
preventionists, with a minimum of 5 years of direct prevention experience prior to their appointment as
state field representatives.
Training and technical assistance to community coalitions will be the responsibility of the APRCs.
Through the SAPT Block Grant, the APRC staff are responsible for providing expert assistance to
community coalitions and agencies. They are also trained and certified preventionists who are
encouraged to implement strategies on behalf of the community, particularly if no coalition exists.
Oklahoma is going to use the Southwest Regional Expert Team (SWRET)—formerly the SW CAPT—for
training and technical assistance needs for its SPF SIG efforts. The state will look outside for other
sources if the SWRET is unable to provide technical assistance in an identified area, but only after
confirming the lack of availability for such assistance through the SWRET.
The Oklahoma State Department of Health provides infrastructure support for Turning Point, a
grassroots network of community coalitions throughout the state. The Turning Point coalitions are
actively engaged in determining local���level public health needs and implementing solutions to improve
community health. Many of Oklahoma’s community coalitions currently partnered with APRCs and are
implementing substance abuse prevention strategies. ODMHSAS and OSDH Turning Point have actively
collaborated to coordinate efforts where possible. Increased collaboration will be necessary when
rolling out the SPF SIG initiative as Oklahoma Turning Point also is continuing to make strides in building
community capacity through public health planning frameworks similar to the SPF. ODMHSAS will
include Turning Point regional staff in SPF staff meetings, coordinate SPF trainings at the state and
community levels with Turning Point staff, and pursue agreements to streamline messaging and project
requirements to avoid burdening coalitions potentially working on both SPF SIG and Turning Point
projects.
ODMHSAS will convene an Evidence‐Based Practices Workgroup consisting of at least five members,
including local experts, community providers, state staff, and Advisory Council members. Although
initially a SPF SIG‐funded effort, Oklahoma plans to use the Workgroup to build its capacity in using
evidence‐based practices in all its mental, emotional, and behavioral health prevention initiatives.
ODMHSAS also intends to develop: written guidelines and procedures laying out principles and
processes for the delivery of training and technical assistance from state staff to the APRCs and from the
ARPCs to the coalitions/communities they serve; systems to assess/monitor the training and technical
assistance needs of the APRCS and of coalitions; and processes for communities and the APRCs to
request training and technical assistance.
Okla homa Department of Mental Health and Substance Abuse Services Page 30
Role of the SEOW
To assist the APRCs in developing their capacity to implement the SPF process, the SEOW coordinator’s
function will evolve as the SPF SIG initiative reaches the community‐level to include a coaching role,
providing technical assistance in needs assessment and data collection. Should the SEOW coordinator
require support in this role, ODMHSAS will contract with additional resources to supply technical
assistance to communities.
The SEOW also will review community workplans to ensure communities choose strategies that logically
connect to their data, that the strategies they choose are evidence based, and that their plan’s
evaluation components test both their fidelity to process and the outcomes of the strategies they have
chosen.
ODMHSAS will make the SEOW available as a tool for other state agencies, including treatment. It is the
state’s intention that the SEOW take on myriad issues related to—but outside the boundaries of—the
state’s identified priority issues (i.e., underage drinking and prescription drug abuse), looking at epi data
not just for substance abuse, but also for mental, emotional, and behavioral disorders sharing
contributing risk factors. In this role, the SEOW will both build its capacity and assist Oklahoma in its
planning, implementation, and evaluation of quality prevention services for children, youth, and families
at the state and local levels.
Each of the agencies represented on the SEOW brings with them all available data on the populations
they serve. Despite this influx of data, the SEOW is still experiencing data gaps. To address these gaps,
the SEOW has established a workgroup whose task it is to examine the lack of data at the State and sub‐state
for certain special populations, including Native Americans, veterans, older populations, and
individuals with mental health issues, among others. The SEOW’s work on gaps in the state’s data across
populations also will include the areas identified below.
• Oklahoma Prevention Needs Assessment Survey (OPNAS)—Randomize, Weight, Disaggregate
Racial Data, and Add Tribal Affiliation
Although the state will make the OPNAS available to all schools—so that any school choosing to
participate may do so—the SEOW also will randomize and weight OPNAS data from a selected
sample. Previously, the state has faced opposition to using these data beyond a community
level; the OPNAS is a powerful instrument, and randomizing and weighting these data will help
validate survey results, making them comparable across counties and therefore allowing them
to be used in a greater capacity.
The SEOW may disaggregate data to classify “American Indian” as its own racial category within
the OPNAS responses, and to further disaggregate these data by specific tribal affiliation.
Oklahoma has the second‐largest American Indian population of any state, and having racial
data for this group would be invaluable in developing culturally competent prevention
programs, practices, and policies, and providing culturally appropriate and sensitive services to
Native populations.
Okla homa Department of Mental Health and Substance Abuse Services Page 31
• Combining existing school surveys—YRBS, OPNAS, and YTS.
Currently, Oklahoma administers the YRBS and the Youth Tobacco Survey (YTS) in schools in
odd‐numbered years, and the OPNAS in even‐numbered years. Although the YTS and YRBS are
administered in the same year, administration efforts are not combined. School participation is
challenging as a result of increasing school burden. To decrease the burden on schools and
increase the likelihood of participation in the state’s school surveys, ODMHSAS plans to work
with its SEOW to propose the coordination of the three surveys so that schools are solicited only
once every 2 years instead of annually.
• BRFSS Prescription Drugs and Illicit Drugs Modules
The BRFSS is a great source of alcohol and tobacco data, but currently does not collect data
regarding illicit and prescription drug use. Its counterpart, the YRBS, does collect illicit drug
information and in 2011 will collect prescription drug information. CSAP suggests using the
BRFSS as a data source for indicators in alcohol and tobacco, but relies on the YRBS for data on
specific drugs—yet the YRBS captures data only for high school students in grades 9–12. NSDUH
captures data on illicit drugs, reporting all illicit drugs as a single category (not by individual
drug, as is done by the YRBS), and also reports data on prescription drug use.
CSAP uses both the BRFSS and NSDUH to address indicators in alcohol and tobacco. Having both
available for illicit drug use—and the BRFSS for specific drug use—would help further identify
and address issues in the state.
• College‐Age Adult Data
Although the BRFSS includes college‐aged individuals, participants are not selected based on
college status, but as part of the population as a whole. The BRFSS is not designed to capture
data on behaviors unique to college students that are important to understanding and serving
this population. What is needed is a survey specific to college students, which collects data
pertaining to alcohol, tobacco, and other drugs; attitudes toward substance use; and risk and
protective factors affecting such use. Although some Oklahoma universities have conducted the
CORE survey and/or the College Health Assessment in the past, the implementation of such
surveys has been inconsistent. Through the SEOW, ODMHSAS plans to work with the state’s
colleges to collect data from this population on a regular basis, developing state and community
competence in addressing the unique prevention needs of college students.
• Low County Numbers
Oklahoma’s rural nature is striking and challenging. Eighty‐nine percent of cities in Oklahoma
have fewer than 3,000 residents, and approximately one‐half of Oklahoma’s 77 counties have a
population density of just 50 people per square mile. Valuable data obtained by national sources
often are unstable or unreportable at such low population levels. Aggregation of data from
multiple counties provides greater numbers and therefore greater stability; however,
Okla homa Department of Mental Health and Substance Abuse Services Page 32
aggregated counties may have more differences than similarities. Addressing this issue will be a
particular challenge for the SEOW.
• Emergency Department Data
Data from overdose deaths do not properly capture the outcomes regarding substance abuse.
Data from emergency departments would allow the SEOW to identify the broad and devastating
health consequences associated with substance abuse.
• Data Query System
Oklahoma’s existing data system (ICIS) was created originally to address the National Outcome
Measures (NOMs) identified for treatment, which focus on client‐specific data collection.
Although this system does not fit well with data collection for the population‐based prevention
NOMs, Oklahoma currently does not have an alternative for its prevention providers. To address
this challenge, ODMHSAS will work with the University of Oklahoma College of Public Health—
the state’s Block Grant evaluator—to identify systems that would be more effective for
collecting data relative to the prevention NOMs. A data query system that includes data
collected from the OPNAS would be tremendously helpful to Oklahoma’s providers, who rely
heavily on the OPNAS to serve their communities and have expressed serious interest in
acquiring a data query system to help with their efforts.
• Prescription Drug Monitoring Program (PMP) Data
Currently, PMP data are housed within the Oklahoma Bureau of Narcotics and Dangerous Drugs.
Legislation has placed significant restrictions on the ways this system may be accessed. In the
course of understanding Oklahoma’s issues with prescription drugs, this data source has been
crucial, yet the SEOW’s use of these data remains extremely limited, rendering critical data
unavailable.
• Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ)
Research has shown that LGBTQ populations are at higher risks for certain substance abuse
issues; however, data regarding these populations are unavailable in the state. Such data would
prove valuable in understanding and addressing the needs of this population, and assisting
communities and the state in developing culturally competent programs, practices, and policies.
Okla homa Department of Mental Health and Substance Abuse Services Page 33
IV. Planning
State Planning Model
The OPLC determined that no area was at higher risk than another for underage drinking, and that
insufficient data were available to determine a “hotspot” for prescription drug abuse (and therefore
justify selecting just one region for this priority issue).
Figure 11. Alcohol Use in Past Month among Persons Aged 12 to 20 in Oklahoma, by Substate Region:
Percentages, Annual Averages Based on 2006, 2007, and 2008 NSDUHs
Figure 12. Binge Alcohol Use in Past Month among Persons Aged 12 to 20 in Oklahoma, by Substate Region:
Percentages, Annual Averages Based on 2006, 2007, and 2008 NSDUHs
Okla homa Department of Mental Health and Substance Abuse Services Page 34
Figure 13. Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older in Oklahoma, by
Substate Region: Percentages, Annual Averages Based on 2006, 2007, and 2008 NSDUHs
Therefore, Oklahoma is using a hybrid equity planning model, with allocation across the state based on
both per capita and need. The model will allocate a baseline amount to each of the 17 APRCs for local
needs and capacity assessment, prioritization, and plan development. Once the submitted plan is
approved, the funding amount needed to implement that plan will be determined based on the
strategies selected and population targeted.
There are a number of reasons that a statewide allocation through the APRC system makes sense. Since
Oklahoma is primarily a rural state with only two large cities—Tulsa and Oklahoma City—the state will
have adequate funds to make an impact on the prioritized issues statewide without sacrificing the
prevention efforts in any region. In addition, by building capacity throughout the entire state, the SPF
will be sustained well beyond the grant period.
The SPF SIG is an infrastructure cooperative agreement and the APRCs are the backbone of Oklahoma’s
prevention system. Therefore, ODMHSAS plans to use its SPF SIG to build the APRCs’ capacity, with the
intention of integrating the new infrastructure into the Block Grant when the SPF SIG has ended.
Although the state plans to fund all 17 APRCs, because Cherokee Nation—awarded its own SPF SIG in
2006—has saturated 2 of the regions (APRCs), ODMHSAS may give a larger share of the SPF SIG funding
(after year 1) to the other 15.
The idea behind using an enhanced intervention site for prescription drug use comes from the literature
(Stanford cardiac study1) that suggests using a pilot site to test unproven (although theoretically
promising) strategies for prescription drugs, not knowing whether or not those strategies will work.
1 The Stanford prevention study was a cardiac study that looked at comparison communities and the importance of
looking at testing communities prior to implementing unproven strategies wholesale, even if in theory they appear
to be a good choice.
Okla homa Department of Mental Health and Substance Abuse Services Page 35
ODMHSAS plans to conduct a more intense evaluation of the enhanced site and compare the results to
another site without the enhanced intervention. The purpose is to isolate an “experimental” strategy,
try it in one community (the enhanced community), evaluate it, and then replicate it. This does not
preclude other communities from choosing to focus on prescription drug abuse, but those sites will be
limited to using the kinds of strategies currently used with alcohol and other drugs.
Community‐Based Activities
The APRCs are going to be required to conduct a thorough needs assessment at the regional level and
will have to choose one or both of the state priorities and identify the priority community or
communities with which they plan to work. Each APRC will be given the latitude to define community in
its own way (e.g., county, city, etc.). The chosen community may or may not have an existing coalition,
but if not, the APRC will be required to develop one. Different communities can be chosen by the same
APRC, and different communities can have different priorities, even if they are chosen by the same
APRC. If the APRC picks a community that has multiple coalitions, it will have to determine which of the
coalitions the project will fit, recognizing that not all coalitions might want to engage as a SPF SIG‐funded
coalition. If Oklahoma identifies a hotspot in an area where a Drug‐Free Community (DFC)
coalition exists, the APRC will consider that coalition for funding, as it should any existing coalition in a
designated hotspot.
To ensure that all SPF SIG funded interventions are evidence‐based, ODMHSAS will convene an
Evidence‐Based Practices Workgroup, as mentioned previously. The Workgroup’s role will be to utilize
CSAP’s guidance document and recommendations to clearly define criteria for Oklahoma to use when
considering the implementation of certain prevention policies, practices, or programs. Oklahoma’s
Evidence‐Based Practices Workgroup will consist of no fewer than five members representing local
experts, community providers, state staff, and OPLC members. The Workgroup also will be responsible
for reviewing community SPF SIG workplans and providing feedback and technical assistance to
community providers and coalitions on the selection, potential adaptation, and fidelity of strategies that
meet the defined evidence‐based criteria.
Allocation Approach
Oklahoma is using a hybrid equity model since statewide prevalence of underage drinking showed this
need to be universal and insufficient data existed to justify choosing a hotspot for prescription drug
abuse prevention. The state will fund each APRC directly.
The first year’s funding will be divided equally among the 17 regions. First‐year funding will be used to
hire a full‐time person in each region to work with the coalition, purchase equipment if needed (e.g., a
computer), and to accommodate local travel (e.g., mileage).
APRCs are not expected to serve the entire region. Rather, each APRC will focus on the highest need at
the community level as determined by the use of community‐level data.
Okla homa Department of Mental Health and Substance Abuse Services Page 36
After the first year, the state will distribute money via a formula. Although this will be similar to what is
used for the SAPT Block Grant (e.g., per capita, per region, with mileage for rural communities), the
same formula will not be used because the SPF SIG communities chosen could be very different (e.g., a
rural region could choose a high‐population county and an urban area could choose a sparsely
populated community). If needed, ODMHSAS may also build in funding for lower capacity communities
versus higher capacity communities.
Each community is expected to develop its own community action plan with support and guidance from
the APRC. The plans must implement environmental strategies focused on population‐level change.
Implications of Allocation Approach
Implications of the allocation approach include
considering whether: 1) the smaller APRCs will
be able to use as much money as they are
allotted, 2) the larger metropolitan areas will
receive adequate funds to complete the grant
requirements, and 3) consumption and/or
consequences can be reduced on a state and
local level. At the state level, ODMHSAS feels it
is important each area receive enough money to
build capacity so the APRCs are able to meet the
requirements of the grant, but not so much so
that there are funds left unspent. This
consideration led to the selection of the
allocation formula described above, which takes
into account both per capita and need. By
funding all APRCs, the entire state system is
exposed to the approach, which provides the
reasonable expectation for change on both the
state and local levels.
As noted above, the Cherokee Nation of Oklahoma was previously awarded a SPF SIG cooperative
agreement. Cherokee Nation funded a number of hub communities that conducted local‐level needs
assessments, selecting as priority issues underage drinking, prescription drugs, adult alcohol misuse, and
methamphetamine use. The Tribal Jurisdictional Service Area (TJSA) is comprised of parts or all of 14
counties in northeastern Oklahoma (see map , right). The same 14 counties in the TJSA are served by 4
APRCs. ODMHSAS has worked closely with Cherokee Nation at the state/tribal government and local
levels to coordinate training, services, and community coalitions among and between service providers.
Okla homa Department of Mental Health and Substance Abuse Services Page 37
V. Implementation
Training and Technical Assistance System
ODMHSAS has committed to the development and implementation of a workforce assessment survey.
This survey will be conducted annually, statewide, and not confined to SPF SIG subrecipients.
In addition, the state field representatives will be aware of any training and technical assistance needed
at the regional and community levels through their daily work with the APRCs. Although all communities
will follow the five‐step SPF process, individual communities may have unique strengths or areas for
enhancements. The state field representatives will bring these needs forward in weekly meetings with
ODMHSAS’s Prevention Program Manager.
Training Procedures
Oklahoma’s SPF SIG evaluator conducted statewide face‐to‐face interviews with state agency staff,
community agencies and officials (e.g., mayors, tribal leaders), and community coalitions to identify skill
development needs for the prevention workforce at both the state and community levels. At the state
level, staff identified the need for a structured, graduated approach to prevention training (i.e., taking
into account the training needs of both new and existing staff), as well as training in management and
leadership skills, ways to merge government and faith community efforts, and methods for supporting
common target populations (e.g., children, families, communities) through multiagency collaborative
efforts. At the local level, coalitions/communities identified the need for assistance in conducting
coalition operations; strategic planning; understanding data and evaluation; effectively using data for
decision‐making; understanding evidence‐based strategies; grant writing; developing strategies for
engaging community members, for changing norms, and for reaching all sectors of the community; and
planning for sustainability.
Oklahoma will require a minimum of one onsite review annually, during which technical assistance
needs for each community will be identified.
Findings from all of these approaches will be used to identify and provide trainings throughout the state.
All of the SPF SIG training opportunities will be disseminated widely and open to tribes and other agency
providers.
ODMHSAS is not going to fund coalitions directly. To avoid duplication of efforts, the state is using its
existing system of APRCs, which already work with coalitions in their regions. Working from their
knowledge of each community, the APRCs are aware of what programming and strategies are already in
place. It is Oklahoma’s goal that each of the communities use the SPF five‐step process to identify needs,
current strategies addressing those needs, and new and appropriate strategies to augment those
already being used.
Okla homa Department of Mental Health and Substance Abuse Services Page 38
VI. Evaluation
Surveillance, Monitoring, and Evaluation Activities
At the state level, ODMHSAS has identified Bach Harrison, L.L.C., as the Project Evaluator.
Process Evaluation
Oklahoma’s SPF SIG evaluator will assess project implementation and overall state‐ and community‐level
progress using select process evaluation measures. Process information will be gathered through a
variety of methods at both the state and community levels, including a review of existing documents
and materials (e.g., the state and community SEOW data profiles and strategic plans, minutes from
project meetings), participation and observations at project meetings, and interviews with project
stakeholders.
Outcome Evaluation
Oklahoma’s evaluator also will assess outcomes at the state and community levels in two overarching
areas: (1) prevention capacity, and (2) priority substance abuse problems.
To assess prevention capacity, Bach‐Harrison will primarily use the stakeholder interviews (with state‐level
project members and community coalition members) discussed above to document changes in
prevention infrastructure and capacity at the state and community levels (including coalitions’ and
member agencies’ capacities). The interviews will be organized around the SPF steps and will place a
particular emphasis on documenting and assessing project capacity‐building activities and
enhancements that correspond to the five steps (e.g., improvements in needs assessment and strategic
planning capacities).
To assess the project’s progress on preventing and reducing underage drinking and prescription drug
abuse, Bach‐Harrison will collect survey data annually and acquire archival data on an ongoing basis
from a variety of state sources and publicly available national sources.
In addition to assessing changes in the priority outcomes, Oklahoma’s SPF SIG evaluator will examine the
intervening variables (causal factors) associated with these ultimate outcomes. The survey and archival
data also will be sources of data for intervening variables.
Tracking
The state’s evaluator will track both process and outcome data. Process data will include demographics
of the population served, number and type of strategies implemented, implementation of the SPF steps,
facilitators of and barriers to project progress, and contextual factors that may affect project progress
and outcomes. The SPF SIG evaluator will use ODMHSAS’s system, ICIS, to collect process data.
Oklahoma has used ICIS as its local reporting and monitoring system for the SAPT Block Grant and has
satisfied all Federal reporting requirements without issue. As part of the cross‐site evaluation, data will
also be collected through the GLI, CLI, and fidelity instruments.
Okla homa Department of Mental Health and Substance Abuse Services Page 39
Outcome data for underage drinking will include past 30‐day alcohol use, binge drinking in the past 30
days, age of first use of alcohol, riding in a car driven by someone who has been drinking, and driving
after drinking. Outcome data for prescription drug abuse will include nonmedical use of prescription
pain relievers in the past month, opioid overdose deaths, emergency room prescription drug abuse
visits, and hospital admissions for prescription drug abuse.
Expected Change
Bach‐Harrison will examine state and community measures to determine if the SPF SIG initiative is linked
to an increase in prevention capacity and lower levels of underage drinking, prescription drug abuse,
and targeted intervening variables. Due to the concentration of SPF resources in the selected
communities, Oklahoma’s evaluator anticipates that SPF effects on community‐level outcomes will be
more pronounced than state‐level outcomes.
NOMs Collection and Submission
The state’s evaluator will use ICIS to collect required NOMs, such as the number of persons served by
age, gender, race, and ethnicity, and total number of evidence‐based programs, policies, and practices.
The evaluator will submit the data electronically twice a year through the CSAP Data Coordination and
Consolidation Center Services Accountability and Monitoring System (DCCC‐CSAMS).
Okla homa Department of Mental Health and Substance Abuse Services Page 40
VII. Cross‐Cutting Components and Challenges
Cultural Competence
In their workplans, the APRCs will be required to indicate how they will be culturally competent, and to
demonstrate inclusion of the coalitions with which they work. Evidence‐based practices workgroup
members will be responsible for confirming that the strategies match the community they expect to
serve, identifying the modifications that can be made, and determining whether those are appropriate
for the targeted population. Environmental approaches are more difficult to adapt and ensure they are
culturally competent. ODMHSAS’s tribal liaison—who is also the Systems of Care Cultural Competency
Advisor—is written in‐kind in SPF SIG to serve as the cultural competence advisor to the SPF.
The state does intend to contract for cultural competence training to the APRCs. ODMHSAS will
purchase or examine tools for providers to help with their development in this area. One example
already in use is Culture Vision, a Web‐based tool for health care that advises providers on the
backgrounds of different populations and general expectations for the different cultures in terms of
health. Oklahoma will look into the viability of adding a prevention module to Culture Vision, and
perhaps may be able to add individual tribes to the tool as well, since Oklahoma is home to 45 distinct
tribes.
Sustainability
Oklahoma’s SAPT Block Grant is on a 5‐year funding cycle. ODMHSAS is considering logistical revisions to
its contracting methods that would help align the SPF SIG and the Block Grant, keeping the initiative
within the same agency throughout the duration of the project. The review committee, which includes
the SEOW, will review all bids, and annually or semiannually review community workplans, involving
more experts in the process. The experts will be responsible for providing the technical assistance
needed to develop the workplans (e.g., SEOW members will provide technical assistance on data
collection and analysis).
Combining Block Grant and SPF SIG efforts will include, eventually, fully integrating the contracting and
SPF processes, and ultimately aligning all prevention efforts with the SPF. The SPF will guide the
approval of state and community strategies, with the review of community workplans asking: Is the
strategy sustainable? How will it be sustained? If communities have to develop coalitions, how are the
coalitions going to be sustained?
The state infrastructure assessment identified areas where Oklahoma will be making improvements for
the long term. Because the state is able to budget the Block Grant for a longer time (than the SPF SIG),
ODMHSAS will fund only those SPF initiatives that reasonably can be sustained by the Block Grant once
the SPF SIG funding has ended.
Every community action plan will be required to include both an evaluation and a sustainability plan.
Communities will receive training on these elements.
Okla homa Department of Mental Health and Substance Abuse Services Page 41
The state purposely developed both its SEOW and the OPLC to continue after the SPF SIG initiatives have
been completed. As stated earlier, the OPLC was established to promote the coordinated planning,
implementation, and evaluation of quality prevention services for children, youth, and families at the
state and local levels. As the state’s focus intensifies on mental, emotional, and behavioral health
disorders as related problems, this council will broaden its focus on state prevention priorities and
coordination among state agencies on prevention services. The same is true for the SEOW, which will
continue to collect and analyze relevant state, tribal, and local data to guide substance use prevention
planning, programming, and evaluation, but will be available to work on any mental, emotional, or
behavioral disorder issue.
Challenges
Needs‐based Allocation
Oklahoma’s data are not sufficient to justify on the allocation of funds on purely a needs‐based process.
As mentioned previously, underage drinking is prevalent statewide, and insufficient data are available to
determine particular hotspots for the nonmedical use of prescription drugs. Communities wishing to
address the latter issues will likely face some challenges concerning data. The literature on prescription
drug use is limited, which will challenge communities to come up with strategies. A lot of data sources
that include prescription drugs combine all drugs for singular reporting, rather than reporting on
prescription drugs as a single class.
The state will have two cycles of prescription drug use data. OPNA collected prescription drug data in
2010 and YRBS will provide prescription drug use data in 2011. Communities currently have local‐level
comparison data from the OPNA that is unavailable at the state level.
Through its proposed enhanced intervention community, Oklahoma hopes to add prescription drug
abuse prevention strategies to the Federal registry of effective and promising practices. If sufficient data
surfaces from evaluation of the enhanced community demonstrating positive outcomes, those
strategies may be considered for service‐to‐science submission.
Implementation of Plan
During the most recent Block Grant bidding cycle, Oklahoma designed a workplan template that aligns
with the SPF, so the APRCs already are familiar with the process. The APRCs also are preventionists who
can implement strategies if need be, in addition to providing technical assistance to coalitions. Under
the upcoming bid, the state will hold the APRCs accountable for building organizational capacity within
coalitions. This will be a challenge for the APRCs on two levels: many of the state’s coalitions may not
yet have the capacity to implement the SPF, and not all coalitions may want to engage in the SPF
process.
One final challenge ODMHSAS expects to encounter in the planning process is communities’ desire to
jump straight to strategies after identifying their priority issues. Oklahoma communities understand why
identifying priorities is necessary, but continue to require assistance to understand the importance of
Okla homa Department of Mental Health and Substance Abuse Services Page 42
identifying intervening variables and targeting strategies to these risk or causal factors to have an impact
on their identified problem behaviors.
Okla homa Department of Mental Health and Substance Abuse Services Page 43
Appendices
Okla homa Department of Mental Health and Substance Abuse Services Page 44
OPLC Membership
Member/Delegate Name AFFILIATION
Secretary Terri White Office of Governor
Pending Appointment Senate Member
Representative McCullough House of Representatives Member
Steve Buck Department of Mental Health & Substance Abuse Services
Kevin Ward Department of Public Safety/Highway Safety Office
Dr. Lynn Mitchell State Department of Health
Howard Hendrick Department of Human Services
Michael Fogarty Health Care Authority
Darrell Weaver Oklahoma Bureau of Narcotics
Sandy Garrett Oklahoma Department of Education
Lisa Smith Oklahoma Commission on Children and Youth
Linda Terrell Oklahoma Institute for Child Advocacy
Lt. Kerri Keck Oklahoma National Guard
Stacy Potter Community‐level Prevention Provider
Dr. BJ Boyd Tribal Behavioral Health
Jane Goble‐Clark Prevention Advisor
Sheila Groves State PTA
Stacey Puckett Oklahoma Chiefs of Police Association
Chancellor Glen Johnson Higher Education
Robert E. Gene Christian Office of Juvenile Affairs
Robin Jones Office of Faith‐Based Initiatives
Dr. Don Baker Prevention Researcher
Okla homa Department of Mental Health and Substance Abuse Services Page 45
SEOW Membership2
Member/Delegate Name Affiliation
Anthony Kibble Oklahoma Commission on Children and Youth
Leslie Ballinger Southwest Regional Expert Team—Epidemiology Consultant
Cortney Yarholar Oklahoma Department of Mental Health and Substance Abuse
Services—Transformation Agency/Tribal Liaison
Connie Schlittler Oklahoma Department of Human Services
David Wright Oklahoma Department of Mental Health and Substance Abuse
Services—Decision Support Services
Courtney Charish Oklahoma Department of Corrections—Statistical Analyst
Stacey Puckett Oklahoma Association of Police Chiefs
Dr. Misty Boyd Cherokee Nation Behavioral Health Services
Patti Shook Osage Nation Prevention Program
Captain Rusty Rhoades Oklahoma Highway Patrol/Department of Public Safety
Derek Pate Oklahoma State Department of Health—Health Care Information
Donald Baker University of Oklahoma, Anne and Henry Zarrow School of Social Work
—Director
Dough Matheny Oklahoma State Department of Health, Department Tobacco
Prevention Service—Chief
Dr. J.C. Smith Oklahoma State Department of Education
Dr. Lee McGoodwin Oklahoma Poison Control Center—Managing Director
Erin Meyer Oklahoma Health Care Authority
Jamie Piatt Oklahoma Department of Mental Health and Substance Abuse
Services—Epidemiologist/SEOW Coordinator
Jessica Hawkins Oklahoma Department of Mental Health and Substance Abuse
Services—Prevention Services Director
Young Onuorah Oklahoma Department of Mental Health and Substance Abuse
Services—Prevention Program Manager
Joyce Morris Oklahoma State Department of Health Tobacco Use Prevention—State
Assessment Coordinator
Scott Schaeffer University of Oklahoma Health Sciences Center
John Hudgens Oklahoma Department of Mental health and Substance Abuse Services‐
Innovation Center Director
Sydney Martinez Oklahoma Tribal Epidemiology Center
Captain Chin U Kim
Oklahoma Air National Guard—Drug Demand Reduction Administrator
Lisa Barnes Wichita Mountain Prevention Network—Executive Director
Liz Langthorn Oklahoma Department of Health—Injury Prevention
Dr. Barbara Masters Oklahoma Veterans Affairs
Patty Martin Bach Harrison LLC—Project Evaluator
2 Unless identified as support or consultant, all are voting members.
Okla homa Department of Mental Health and Substance Abuse Services Page 46
Rashi Shukla University of Central Oklahoma—Department of Sociology
Scott Schaeffer Oklahoma Poison Control Center—Assistant Managing Director
Shannon Rios Oklahoma Department of Human Services—Research Manager
Sheryll Brown Oklahoma State Department of Health—Director of Violence
Prevention Programs
Don Vogt Oklahoma Bureau of Narcotics
Stephanie U’Ren Oklahoma Department of Mental Health and Substance Abuse
Services—Community Partnership Manager
Samuel McClendon Oklahoma Department of Mental Health and Substance Abuse
Services—Prevention Field Representative
Joy Hermansen Oklahoma Department of Mental Health and Substance Abuse
Services—Prevention Field Representative
Okla homa Department of Mental Health and Substance Abuse Services Page 47
Regional Network Map
Okla homa Department of Mental Health and Substance Abuse Services Page 48
Epidemiological Data Sources
Alcohol Epidemiologic Data System (AEDS) • AEDS is responsible for maintaining, and extending an
alcohol‐related epidemiologic databank. AEDS also compiles the Alcohol Epidemiologic Data Directory
which is a current listing of surveys and other relevant data suitable for epidemiologic research on
alcohol.
Behavioral Risk Factor Surveillance Survey (BRFSS) • Established in 1984 by the Centers for Disease
Control and Prevention (CDC), the Behavioral Risk Factor Surveillance System (BRFSS) is a state‐based
system of health surveys that collects information on health risk behaviors, preventive health practices,
and health care access primarily related to chronic disease and injury. For many states, the BRFSS is the
only available source of timely, accurate data on health‐related behaviors. Oklahoma has participated in
BRFSS since 1995. This report focused on 2007 BRFSS data to give a current picture of substance
use/abuse in Oklahoma. http://www.cdc.gov/brfss/about.htm
Bureau of Justice • The Bureau of Justice Statistics was first established on December 27, 1979 under
the Justice Systems Improvement Act of 1979. The Bureau of Justice Statistics (BJS) is a component of
the Office of Justice Programs in the U.S. Department of Justice.
Center for Disease Control and Prevention (CDC) • The CDC, a part of the U.S. Department of Health
and Human Services, is the primary Federal agency for conducting and supporting public health activities
in the United States. CDC’s focus is not only on scientific excellence but also on the essential spirit that is
CDC – to protect the health of all people. CDC keeps humanity at the forefront of its mission to ensure
health protection through promotion, prevention, and preparedness.
Fatal Analysis Reporting System (FARS) • FARS contains data on all fatal traffic crashes within the 50
states, the District of Columbia, and Puerto Rico. The data system was conceived, designed, and
developed by the National Center for Statistics and Analysis (NCSA) to assist the traffic safety
community in identifying traffic safety problems, developing and implementing vehicle and driver
countermeasures, and evaluating motor vehicle safety standards and highway safety initiatives.
National Survey on Drug Use and Health (NSDUH) • The National Survey on Drug Use and Health
(NSDUH) provides annual data on drug use in the United States. The NSDUH is sponsored by the
Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Public
Health Service and a part of the Department of Health and Human Services (DHHS). The survey provides
yearly national and state‐level estimates of alcohol, tobacco, illicit drug, and non‐medical prescription
drug use. Other health‐related questions also appear from year to year, including questions about
mental health. The NSDUH findings were used to evaluate substance use/abuse from the age of 12. This
survey is not a school based survey so it provides a different perspective than the YRBS for youth.
https://nsduhweb.rti.org
National Vital Statistics System (NVSS) • The National Vital Statistics System is the oldest and most
successful example of inter‐governmental data sharing in Public Health and the shared relationships,
standards, and procedures form the mechanism by which NCHS collects and disseminates the Nation's
Okla homa Department of Mental Health and Substance Abuse Services Page 49
official vital statistics. These data are provided through contracts between NCHS and vital registration
systems operated in the various jurisdictions legally responsible for the registration of vital events –
births, deaths, marriages, divorces, and fetal deaths.
Oklahoma Bureau of Narcotics and Dangerous Drugs (OBN) • The Oklahoma State Bureau of Narcotics
and Dangerous Drugs Control is a law enforcement agency with a goal of minimizing the abuse of
controlled substances through law enforcement measures directed primarily at drug trafficking, illicit
drug manufacturing, and major suppliers of illicit drugs.
Oklahoma Department of Corrections (ODOC) • Following the enacting of the Oklahoma Corrections
Act of 1967, the new Department of Corrections was created on July 1, 1967. The ODOC is a network of
facilities comprised of 17 institutions, seven Community Corrections Centers, and 15 Community Work
Centers. The incarcerated women data was obtained from the ODOC.
Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) • The ODMHSAS
was established in 1953 and continues to evolve to meet the needs of all Oklahomans. Collaborating
with leaders from multiple state agencies, advocacy organizations, consumers and family members,
providers, community leaders and elected officials, the way has been paved for meaningful mental
health and substance abuse services transformation in Oklahoma. The ODMHSAS is responsible for
providing services to Oklahomans who are affected by mental illness and substance abuse.
Oklahoma Prevention Needs Assessment Survey (OPNA) • The Oklahoma Prevention Needs As‐sessment
is a paper/pencil survey administered in opposite years of the YRBS in schools to 6th, 8th, 10th
and 12th grade students. The survey is designed to assess students’ involvement in a specific set of
problem behaviors, as well as their exposure to a set of scientifically validated risk and protective
factors. In 2008, 60,720 students were surveyed from 686 schools across 74 of Oklahoma’s 77 counties.*
The major limitation of this survey is that it is not a random sample; schools choose whether or not they
participate, making it a convenience sample.
Oklahoma State Bureau of Investigation (OSBI) • The Oklahoma State Bureau of Investigation Uniform
Crime Reporting (UCR) Program is part of a nationwide, cooperative statistical effort.
Oklahoma State Department of Health (OSDH) • The OSDH is a department of the government of
Oklahoma responsible for protecting the health of all Oklahomans and providing other essential human
services and through its system of local health services delivery, is ultimately responsible for protecting
and improving the public’s health status through strategies that focus on preventing disease. The OSDH
serves as the primary public health protection agency in the state.
Oklahoma Tax Commission • Since 1931, the Oklahoma Tax Commission has held the responsibility of
the collection and administration of taxes, licenses and fees that impact every Oklahoman. Under the
direction of the state legislature, the Tax Commission manages not only the collection of taxes and fees,
but also the distribution and apportionment of revenues to various state funds. The collected revenues
fuel such state projects as education, transportation, recreation, social welfare and a myriad of other
services.
Okla homa Department of Mental Health and Substance Abuse Services Page 50
Oklahoma Violent Death Reporting System (OKVDRS) • Oklahoma and 16 other states (Massachusetts,
Maryland, New Jersey, Oregon, South Carolina, North Carolina, Virginia, Alaska, Colorado, Georgia,
Wisconsin, Rhode Island, Kentucky, Utah, New Mexico and California) participate in the National Violent
Death Reporting System. Violent deaths include homicides, suicides, deaths from legal intervention,
unintentional firearm deaths, deaths of undetermined manner and deaths from acts of terrorism. Data
for OKVDRS are collected from death certificates, medical examiner reports, police reports, supple‐mental
homicide reports and crime labs. Standardized methodology and coding are used to collect the
data and enter into a database that is housed at the Oklahoma State Department of Health (OSDH). The
OSDH partners with the Oklahoma State Bureau of Investigation and the Oklahoma Medical Examiner’s
Office to collect the data.
Oklahoma Youth Tobacco Survey (OYTS) • Designed to provide comprehensive data for planning and
evaluating progress toward reducing tobacco use among youth. Items measured as part of the OYTS
survey include correlates of tobacco use such as demographics, minors’ access to tobacco, and exposure
to secondhand smoke. It provides data representative of Oklahoma middle school and high school
youth’s tobacco‐related beliefs, attitudes and behaviors, and exposure to pro‐ and anti‐tobacco
influences such as curricula and media. The data can be compared to results from the National Youth
Tobacco Survey and results from other states.
Pacific Institute for Research and Evaluation (PIRE) • PIRE is one of the Nation’s preeminent inde‐pendent,
nonprofit organizations focusing on individual and social problems associated with the use of
alcohol and other drugs. PIRE is dedicated to merging scientific knowledge and proven practice to create
solutions that improve the health, safety, and well‐being of individuals, communities, nations, and the
world.
Pregnancy Risk Assessment Monitoring System (PRAMS) • PRAMS was initiated in 1987 with a goal to
improve the health of mothers and infants by reducing adverse outcomes such as low birth weight,
infant mortality and morbidity, and maternal morbidity. PRAMS provides state‐specific data for planning
and assessing health programs and for describing maternal experiences that may contribute to maternal
and infant health.
Smoking Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) • SAMMEC is an internet‐based,
computational application. SAMMEC calculates annual state‐ and national‐level smoking‐attributable
deaths and years of potential life lost for adults and infants in the United States. The Adult
application also calculates medical expenditures and productivity costs among adults. Likewise,
Maternal and Child Health (MCH) SAMMEC estimates annual state‐ and national‐level smoking‐attributable
deaths and years of potential life lost for infants.
Substance Abuse and Mental Health Services Administration (SAMHSA) • The Substance Abuse and
Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human
Services (HHS), focuses attention, programs and funding on promoting a life in the community with jobs,
homes and meaningful relationships with family and friends for people with or at risk for mental or
Okla homa Department of Mental Health and Substance Abuse Services Page 51
substance use disorders. The Agency is achieving that vision through an action‐oriented, measurable
mission of building resilience and facilitating recovery.
The Uniform Crime Report (UCR) • The UCR was conceived, developed, and implemented by law en‐forcement
for the express purpose of serving as a tool for operational and administrative purposes.
Under the auspices of the International Association of Chiefs of Police, the UCR Program was developed
in 1930. Prior to that date, no comprehensive system of crime information on a national scale existed.
The Oklahoma State Bureau of Investigation assumed the statewide administration of the UCR Program
on September 1, 1973. Statistical information was collected and compiled through the year 2007 with a
comparative analysis of the years 2006 and 2005.
United States Census Bureau • The Census Bureau serves as the leading source of quality data about
the Nation’s people and economy. The bureau of the Commerce Department, responsible for taking the
census, provides demographic information and analyses about the population of the United States.
Census data was used for all Oklahoma demographics.
http://www.census.gov/main/www/aboutus.html
Youth Risk Factor Behavioral Survey (YRBS) • The Youth Risk Behavior Surveillance System (YRBSS)
monitors six categories of priority health‐risk behaviors among youth and young adults, including
behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug
use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs),
including human immunodeficiency virus (HIV) infections; unhealthy dietary behaviors; and physical
inactivity. YRBSS includes a national school‐based survey conducted by CDC and state and local school‐based
surveys conducted by state and local education and health agencies. Oklahoma has participated
in the YRBS since 2003.
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Timelines and Milestones
Activity
Date Agency Responsible
RFP released
January 2011 ODMHSAS
Proposals submitted
February 2011 APRC
Proposals reviewed and approved
February 2011 ODMHSAS
Awards made
March 2011 ODMHSAS
Start date
April 1, 2011 APRC
Subrecipient staff hired May 1, 2011 APRC
Technical assistance on developing a workplan using
the SPF model
May–November 2011
ODMHSAS
Workplans developed
May–November 2011 APRC
Workplans submitted
November 30, 2011 APRC
Workplans reviewed and approved
December 31, 2011 ODMHSAS
Implementation start date
January 1, 2012 APRC
Okla homa Department of Mental Health and Substance Abuse Services Page 53
References
1. Centers for Disease Control and Prevention (CDC). 2003–2009 Youth Risk Behavior Survey. Access:
www.cdc.gov/yrbss
2. CDC. Behavioral Risk Factor Surveillance System Survey Data [2003‐2009]. Atlanta, Georgia: CDC.
3. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National
Survey on Drug Use and Health,[2003–2007]. Rockville, MD: SAMHSA/OAS.
4. CDC. Pregnancy Risk Assessment Monitoring System [2003–2007]. Access:
http://www.cdc.gov/prams/CPONDER.htm
5. Hoyert, D. L., Heron, M. P., Murphy, S. L., et.al. (2006). “Deaths: Final Causes for 2003.” Division of
Vital Statistics Reports, 54(13).
6. Kung, H. C., Hoyert, D. L., Xu, J., et.al. (2008). “Deaths: Final Causes for 2005.” Division of Vital
Statistics Reports, 56(10).
7. Minino, A. M., Heron, M. P., Murphy, S. L., et al. (2007). “Deaths: Final Causes for 2004.” Division of
Vital Statistics Reports, (55)19.
8. U.S. Department of Justice, Federal Bureau of Investigation. Uniform Crime Reporting Program
Data, 2003–2009.
9. National Highway Traffic Safety Administration. Fatality Analysis Reporting System 2003–2008.
Washington, D.C.: Department of Transportation, National Highway Traffic Safety Administration.
10. Heron, M. P. “Deaths; Leading Causes for 2006.” (2009). National Vital Statistics Reports, 57(14).
11. Oklahoma State Department of Health, Health Care Information Division. Oklahoma Hospital
Inpatient Data 2003–2008. Hospitalizations associated with Opiates ICD9 Code 965.0.
12. Warner, M., Chen, L. H., Makuc, D. M. (2009). “Increase in fatal poisonings involving opioid
analgesics in the United States, 1999–2006.” NCHS Data Brief, Number 22. Hyattsville, MD: National
Center for Health Statistics.
13. Oklahoma Department of Mental Health and Substance Abuse Services. Oklahoma’s State Plan on
Aging, 2007–2010.
14. Oklahoma City Heartline. Call Volume Quarter 1, 2008–2010.
15. Oklahoma State Department of Health. Injury Prevention Service. Summary of Violent Deaths in
Oklahoma: Oklahoma Violent Death Reporting System, 2004–2007.
16. Oklahoma Department of Mental Health and Substance Abuse Services. Statistics. Access:
http://www.ok.gov/odmhsas/Statistics_and_Data/Statistics/
17. Oklahoma Systems of Care Wraparound Initiative. Youth Enrolled. Fiscal Years 2006–2010.
18. Oklahoma Department of Mental Health and Substance Abuse Services. Oklahoma State
Epidemiological Outcomes Workgroup. 2009 Epidemiological Profile